Bmle Secrets Compress

2014-2015
This book focuses on the high yield essential content for

the most commonly encountered problems in the exam
PROVEN, PRACTICAL TOOLS TO HELP YOU PASS THE EXAM
Abdulla Ali Isa, MBBS

‫الرِحي ِم ﴾‬ ‫﴿ بِ ْس ِم اللّ ِه َّ‬
‫الر ْْحَ ِن َّ‬
‫ك ْاْلَ ْكَرم ﴿‪ ﴾٣‬الَّ ِذي َعلَّ َم‬
‫نسا َن ِم ْن َعلَق ﴿‪ ﴾٢‬اقْ َرأْ َوَربُّ َ‬ ‫ِ‬
‫ك الذي َخلَ َق ﴿‪َ ﴾١‬خلَ َق ْاْل َ‬
‫اقْ رأْ بِاس ِم ربِّ َّ ِ‬
‫َ ْ َ َ‬
‫نسا َن َما ََلْ يَ ْعلَ ْم ﴿‪﴾٥‬‬ ‫َّ ِ‬ ‫ِ ِ‬
‫بالْ َقلَم ﴿‪َ ﴾٤‬عل َم ْاْل َ‬
‫سورة العلق‬
Content
1- Preface
2- General information about BMLE
3- Cardiology
4- Respiratory
5- Infectious diseases
6- Gastroenterology
7- Hematology and Oncology
8-Nephrology
9- Endocrinology
10- Rheumatology
11- Neuroscience
12- Pediatrics
13- Obstetrics and Gynecology
14- Surgery
15- Orthopedic surgery
16- Otorhinoloryngology
17- Ophthalmology
18- Family medicine
19- Emergency medicine
20- Psychiatry
21- Dermatology and Immunology
22- Objective Structured Clinical Examination
Preface
Preparing for and doing well on the BMLE are essential requirements on
the road to becoming a practicing physician in Kingdom of Bahrain. This
book have been designed to be a great “memory aid” and “last minute
review” so that you have the key facts required to pass the exam.
The material has been selected based on my own experience revising
and taking BMLE. I have written this book in order to provide the
maximum amount of information with the minimum words and help you
in the decision making process.
The logical arrangement of medical facts will make it possible to review
most common BMLE subjects just a few days before the exam. I believe
that this approach will be most helpful for final year medical students
and interns.
Best luck on your BMLE.

Abdulla Ali Isa
Abdullaali10@live.com
General information about BMLE
What is BMLE? -BMLE is Bahrain Medical Licensure Exam.
Who is responsible for organizing the exam? -The National Health Regulatory Authority.
Importance of BMLE -It is the first step for licensing of the graduated Bahraini
physicians to practice medical specialty in the Ministry of
Health and other governmental and non-governmental
health services in the Kingdom of Bahrain. So, It is the
way that transfers you from Intern into
doctor/Physician.
Examination committee -The Examination committee consists of Consultants
from the Ministry of Health specialized in medical
education and representing major disciplines in primary
and secondary healthcare. But a consultant family
medicine is the essential member and responsible for
setting the exam.
Examination content •Multiple Choice Questions (MCQs)
•Objective Structured Clinical Examination (OSCE)
Multiple Choice Questions (MCQs);
The exam takes 3 hours (180 minutes). Subject Estimated number of
questions
Internal medicine 50
Obstetrics and 30
gynecology
Pediatrics 30
Family medicine 15
Miscellaneous 15
(Ophthalmology, ENT,
Dermatology, Psychiatry)
Surgery 10
Objective Structured Clinical Examination (OSCE); -This exam constituted of 20 various clinical stations
Each station takes 5 minutes. including;
-ECG, Dummies, Slides, Photos, Laboratory reports,
Calculation, Radiographs, Tools, etc…
Scoring •The scoring of written paper (MCQs) is done by the
computer and all questions are given equivalent credit
point.
•The OSCE marking is done by a panel of examiners.
•The written exam carries 60% of the total and the OSCE
is 40 %. Candidates should score 50 % or above in the
written exam to be eligible to sit for the OSCE. The final
passing score is the cumulative of 60 % or above from
both written and OSCE examinations.
Cardiology
The most common
Question Answer
1 Causative organism of subacute bacterial endocarditis Viridans Streptococci
2 Causative organism of myocarditis Coxsackievirus
3 Cause of constrictive pericarditis in developing countries Tuberculosis
4 Cause of heart failure Ischemic heart disease
5 Cause of Ischemic heart disease Atherosclerotic disease
6 Complication of chronic atrial fibrillation Cerebrovascular accident
7 Calcium channel blocker causing constipation Verapamil
8 Cause of left ventricular hypertrophy Hypertension
9 Modifiable risk factor for cardiovascular disease (CVD) Essential hypertension
10 Cause of secondary hypertension Renal artery stenosis
11 Cause of acute infectious endocarditis worldwide Staphylococcus aureus
12 Cause of right heart failure in adults Left heart failure
13 Cause of death in a patient with MI during the first 72 hours Arrhythmia
14 Cause of death in a patient with MI after the first 72 hours Myocardial re-infarction
15 Type of congenital defect of the aortic valve Bicuspid aortic valve
16 Characteristic manifestation of a floppy mitral valve Midsystolic click
Type of shock Most common cause

 Cardiogenic Myocardial Infarction
 Septic E.Coli and Staphylococcus aureus
 Neurogenic Spinal cord injury in the cervical or thoracic region
 Hypovolemic Massive hemorrhage
Diagnostic or radiological tool

 The most appropriate next step in diagnosis of a patient presented with a history suggestive of
acute bacterial endocarditis is Echocardiogram.
 Ergonovine echocardiography before coronary angiography is safe and can be used as a reliable
diagnostic screening test for coronary vasospasm in patients with negative treadmill or normal
stress myocardial perfusion scan results.
 Pre-CABG carotid Doppler is routinely recommended, because concomitant carotid disease is
often associated with CAD.
 The best predictor of sudden cardiac death is an ejection fraction ≤ 35%.
 The most appropriate next step in management of a patient diagnosed to have
streptococcal bovis endocarditis with vegetation is colonoscopy, because it is associated
with colonic pathology ranging from diverticuli to polyps to colon cancer.
 Vasovagal type of syncope can be tested by tilt table testing which will demonstrate
hypotension and bradycardia.
Laboratory markers
 Brain natriuretic peptide (BNP) A marker for Heart failure and helps to distinguish congestive
heart failure from pulmonary pathology as the etiology of
dyspnea
 Troponin The Preferred marker for detecting myocardial cell injury
Risk factors
Question Answer
 The most important risk factor for stroke Hypertension
 The greatest risk for stroke in a patient with atrial Previous history of stroke
fibrillation
Medical signs
Question Answer
 The most supportive sign of Congestive Heart Raised jugular venous pressure
Failure (JVP)
 Cardiogenic shock is associated with Raised jugular venous pressure
(JVP)
 The most reliable sign of left heart failure S3 heart sound
Coronary Artery disease

Most dangerous risk factor Elevated low density lipoprotein
Most common risk factor Hypertension
Most likely beneficial measure to decrease the risk Regular exercise
Heart disease Hypertrophic obstructive Mitral valve prolapse Most murmurs

cardiomyopathy
Effect of Valsalva The murmur increases in The murmur of Decrease in length and
maneuver loudness. becomes longer, and intensity.
may also become
louder.
Angiotensin converting enzyme inhibitor

-ACEIs are -ACE inhibitor- -The best agent used -ACEI is not useful in
contraindicated in induced cough is to decrease mortality treatment of Angina
renal artery stenosis, thought to be rate in patients with pectoris.
pregnancy and in a mediated by congestive heart
patient with previous bradykinin and failure, and diabetic
history of substance p. nephropathy is ACEI.
angioneurotic edema.
Electrolyte Imbalance ECG findings
 Hyperkalemia Tall peaked T waves (first sign); a wide QRS; PR prolongation; and loss of
 p waves.
 Hypokalemia T-wave flattening, U waves, and ST-segment depression
 Hypercalcemia short QT interval
 Hypocalcaemia prolonged QT interval and ST segment
 Hypomagnesaemia Prolonged PR and QT interval
Myocardial infarction
Anatomical location Coronary Artery ECG findings (ST changes)
Anteroseptal wall Left anterior descending coronary artery ST elevation in leads V1-V4
(Worst prognosis)
Lateral wall Left Circumflex coronary artery ST elevation in Leads I, aVL, and V5- V6
Posterior wall Left Circumflex coronary artery ST depression in leads V1-V2
Inferior wall Right coronary artery ST elevation in II, III and aVF
The murmurs
 Mitral stenosis Diastolic rumble with opening snap.
 Mitral regurgitation Holosystolic blowing murmur radiating to axilla.
 Mitral valve prolapse Mid-systolic click.
 Hypertrophic cardiomyopathy Systolic, brisk upstroke, parasternal heave.
 Patent ductus arteriosus Continuous, machinery murmur.
 Atrial septal defect Fixed, split S2.
 Ventricular septal defect Holosystolic murmur radiating to the right lower sternal border.
 Aortic regurgitation Water-hammer pulse, decrescendo mid-diastolic.
 Aortic stenosis Harsh, crescendo/decrescendo systolic murmur radiating to
carotids.
 Tricuspid regurgitation Holosystolic murmur radiating to the left upper sternal border.
 Tricuspid stenosis Diastolic decrescendo murmur
Cardiomyopathy
Dilated (Congestive) Hypertrophic Restrictive
 Dilated ventricle,  Ventricular  Low ventricular
normal wall thickness. hypertrophy. compliance.
 Left and right  Small cavity. (Restricts diastolic filling)
ventricular failure.  Septum may obstruct
outflow.
Caused by: Caused by: Caused by:
o Alcohol (Most o Often genetic o Amyloidosis
common) Most cases are o Sarcoidosis
o Doxorubicin autosomal dominant. o Hemochromatosis
o Infection (usually
viral)
Cardiovascular pharmacology
Drugs Comment
 Metoprolol Cardioselective drug that could be used in patients with COPD.
 Metoprolol Used as an Anti-Arrhythmic drug post myocardial infarction.
 Beta blockers Primary treatments for symptomatic mitral valve prolapse.
 Beta blockers Contraindicated in treating cocaine induced arrhythmias.
 Digoxin Contraindicated in Hypertrophic obstructive cardiomyopathy.
 Epinephrine First step in management of anaphylactic reaction.
 Norepinephrine Recommended first-line vasopressor agent to correct hypotension in
patients with sepsis.
 Heparin The most effective proven treatment to prevent progression of unstable
angina to myocardial infarction.
 Aspirin The only treatment that has been shown to reduce postoperative
cerebrovascular events in patients undergoing coronary artery bypass
grafting in the first 48 hours after surgery.
 NSAIDs Should be avoided - If possible- in patients with heart failure,
because they cause sodium and water retention, as well as an
increase in systemic vascular resistance which may lead to cardiac
decomposition.
 Atorvastatin (Lipitor) An antihyperlipidemic agent that provides greater reduction in LDL
levels.
 Fludrocortisones, Effective treatments for chronic orthostatic hypotension.
Midodrine, and
Physostigmine
Wolff-Parkinson-White syndrome
Treatment Drugs must be avoided
 Procainamide (treatment of choice)  Adenosine
 Amiodarone  Digoxin
 Cardioversion  Calcium channel antagonists
 A destruction of the abnormal  Beta blockers
electrical pathway by radiofrequency
catheter ablation (definitive treatment)
Classic clinical clues that suggest a diagnosis of renal-artery stenosis

 The onset of stage 2 hypertension (blood pressure >160/100 mm Hg) after 50 years of
age or in the absence of a family history of hypertension.
 Hypertension associated with renal insufficiency, especially if renal function worsens
after the administration of an agent that blocks the renin-angiotensin-aldosterone
system.
 Hypertension with repeated hospital admissions for heart failure.
 Drug-resistant hypertension (defined as blood pressure above the goal despite treatment
with three drugs of different classes at optimal doses).
Definitions
Question Answer
 The most probable diagnosis of a patient presented with high BP, Coartication of
radiofemoral delay, left ventricular hypertrophy on ECG, and (3 Aorta
figure sign), cardiomegaly and rib notching on CXR
 The most probable diagnosis of a patient presented with high Aortic dissection
blood pressure and unequal pulse
 Acute myocardial damage most often occurring in post Tako-Tsub
menopausal women immediately following an overwhelming cardiomyopathy
emotionally stressful event and it leads to ballooning of left
ventricular apex and dyskinesis. Its mechanism involved massive
catecholamine discharge.
 A collection of three medical signs associated with acute cardiac Beck's triad
tamponade, an emergency condition wherein fluid accumulates
around the heart and impairs its ability to pump blood. The signs
are low arterial blood pressure, distended neck veins, and distant,
muffled heart sounds.
 A type of angina is more common in female than male and it could Prinzmetal angina
present with ST segment elevation more than ST segment
depression.
CHA2DS2-VASc: It is a clinical prediction rule for estimating the risk of stroke in patients with non-
rheumatic atrial fibrillation (AF), a common and serious heart arrhythmia associated with
thromboembolic stroke. It is used to determine whether or not treatment is required with
anticoagulation therapy or antiplatelet therapy.
Risk factors:
- Congestive heart failure (or Left ventricular systolic dysfunction)
-Hypertension
- Age ≥75 years
- Diabetes Mellitus
-Prior Stroke or TIA or thromboembolism
- Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque)
- Age 65–74 years
- Sex category (i.e. female sex)
Treatment of a patient with no/low risk factors Treatment of a patient with Moderate or High
risk factors
Aspirin Oral anticoagulant with a goal INR of 2.0-3.0
Apoprotein A1
 It is inversely related to cardiovascular disease risk.
 Levels are increased in nephritic syndrome.
 It is associated with high density lipoprotein.
 It is involved in removal of cholesterol by HDL from tissues and facilitates transfer back to
VLDL and the liver. It is not a component of chylomicrons.
Questions and answers
What are the types of What are the What is the What are the effects
arrhythmia that often indicators of carditis recommended of Dobutamine and
disappear with in a patient with Antibiotic Regimen for Dopamine?
excretion? rheumatic heart Infective endocarditis
disease? Prophylaxis?
-Premature -Presence of diastolic -Amoxicillin 2 gram -Dobutamine increases
ventricular or long systolic orally 1 hour before inotropy without
contractions (PVC). murmurs. each procedure. vasoconstriction.
-Premature atrial -Pericarditis. - Dopamine increases
contractions (PAC). -Cardiomegaly. inotropy with
vasoconstriction.
‫‪Notes‬‬
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Respiratory
The most common
Question Answer
1 Causative organism of typical community-acquired pneumonia Streptococcus pneumoniae
2 Causative organism of atypical community-acquired pneumonia Mycoplasma pneumoniae
3 Causative organism of Hospital-acquired pneumonia Gram-negative bacilli such as E.Coli
and Pseudomonas, Enterobacter,
Klebsiella, Proteus
4 Causative organism of community-acquired pneumonia in Klebsiella pneumonia
chronic alcoholics
5 Nursing home–acquired pneumonia Methicillin-resistant
Staphylococcus aureus (MRSA) and
Pseudomonas Aeruginosa
Respiratory Infections
 Gram-negative diplococci Moraxella catarrhalis
 Gram-positive diplococci in chains Streptococcus pneumoniae
 Gram-positive cocci in clusters Staphylococcus aureus
 Gram-negative rods Corynebacterium diphtheria
 Gram-positive rods -Klebsiella
-Enterobacter
-Proteus
Radiology
 The most appropriate study to perform to distinguish between pleural fluid and pleural thickening is
decubitus chest radiograph.
 Chest X-ray of incomplete (ball-valve type) obstruction of main bronchus will show hyperinflation of
ipsilateral lung on expiration.
 Pulmonary edema is associated with frothy sputum. Chest x-ray showed Bat-wing appearance.
Pharmacology
 The primary treatment of pulmonary Embolism is anticoagulant.
 The most appropriate empiric therapy for nursing home–acquired pneumonia in a patient with
no other underlying disease is Levofloxacin.
 Patients with carbon monoxide poisoning should be treated immediately with normobaric oxygen, which
speeds up the excretion of carbon monoxide.
 The most likely drug that causes hypoxemia due to large V/Q mismatch (loss of hypoxic pulmonary
vasoconstriction) is Nitroprusside.
Obstructive pulmonary disease Restrictive pulmonary disease
-FEV1/FVC <75% -FEV1/FVC ≥75%
-COPD (irreversible) -Sarcoidosis
-Asthma (reversible) -Pigeon Fanciers lung
-Extrinsic allergic alveolitis
How to differentiate between COPD and Asthma?

-Through Bronchodilator challenge
Asthma COPD
-Increase in FEV1 -No change in FEV1
How to differentiate between chest wall weakness and Interstitial lung disease?
-Through Carbon Monoxide Diffusing Capacity (DLCO)
chest wall weakness Interstitial lung disease
-Normal DLCO -Decrease in DLCO
Asthma
-The best initial tests in acute asthmatic exacerbation -ABG
-The peak expiratory flow (PEF)
-Symptomatic indicator -Increase in FEV1 of more than 12% with the use of
Albuterol
-The best indicator of severity of Asthma -Respiratory rate
-The single most accurate diagnostic test of stable - A 20% decrease in FEV1 with the use of
asymptomatic asthmatic patient Methacholine or histamine.
Asthmatic drugs that must used as a combination Asthmatic drugs that must used both monotherapy
therapy only and combination therapy
 Long-acting B2 agonists  Inhaled corticosteroids
 Leukotriene-receptor antagonists
 Short-acting B2 agonists
 Mast cell stabilizers
-Recommended monotherapy for symptomatic COPD patients with FEV1 less than 60% is either :
-Long acting anticholinergic or
-Long acting B- agonist e.g. Salemetrol
-Plus a rescue therapy with a short acting B agonist
Asthma
 Chronic inflammatory disorder of the airways.
 Episodic or chronic symptoms of airflow obstruction; breathlessness, cough, wheezing, and chest tightness.
 Symptoms frequently worse at night or in the early morning.
 Prolonged expiration and diffuse wheezes on physical examination.
 Limitation of airflow on pulmonary function testing or positive bronchoprovocation challenge.
 Complete or partial reversibility of airflow obstruction, either spontaneously or following bronchodilator
therapy.
Type Definition Medications
Mild intermittent  symptoms≤ 2 times a week. No daily medication
 Asymptomatic and normal Peak expiratory
Flow between exacerbations.
 Exacerbations brief (few hours to few
days); intensity may vary.
 Nighttime symptoms ≤ 2 times a month.
Mild persistent  Symptoms > 2 times a week but < 1 time a  Low dose inhaled corticosteroid
day or
 Exacerbation may affect activity  Cromolyn/nedocromil
 Nighttime symptoms > 2 times a month or
 Theophylline/leukotriene
modifier
Moderate  Daily symptoms  Low-medium dose inhaled
persistent  Daily use of inhaled short-acting B2 corticosteroid
agonist and
 Exacerbation affect activity  Long acting bronchodilator
 Exacerbation ≥ 2 times a week; may last (long-acting inhaled B2 agonist,
days sustained-release theophylline
 Nighttime symptoms > 1 time a week or long acting B2 agonist
tablets)
Severe persistent  Continual symptoms  High dose inhaled
 Limited physical activity corticosteroid
 Frequent exacerbation and
 Frequent nighttime symptoms  Long acting bronchodilator
(long-acting inhaled B2 agonist,
sustained-release theophylline
or long acting B2 agonist
tablets)
and
 Corticosteroid tablets or syrup
o In quick relief medication, we used short acting inhaled B2 agonists as needed in mild intermittent type and
on daily basis in other types.
o Long-acting B2 agonist must not be used as monotherapy.
COPD
 The best diagnostic test of COPD is Spirometry.
 The most common organism associated with acute exacerbation of chronic bronchitis is
H.Influenza.
 The most common etiology of COPD is cigarette smoking.
 Inhaled corticosteroids will not reduce mortality or affect long-term progression of COPD.
However, they do reduce the number of exacerbations and the rate of decline in the quality of
life. These agents do have side effects, including candidal infection of the oropharynx,
hoarseness, and an increased risk of developing pneumonia.
 The most important task that will increase survival in COPD patient is smoking cessation.
 Home oxygen increases the survival of patients with COPD.
Sleep disturbance
 Most (85%) insomnias are secondary; physiological, psychiatric, physical and drug-induced.
 Alcohol decreases total sleep time and the time required to fall asleep.
 Narcolepsy is associated with an irresistible urge to sleep and usually presents in the first to
second decade.
 Hypersomnia consists of ‘hangover’ symptoms caused by excessive sleep, which leads to the
need for more sleep.
 The most likely diagnosis of an obese male presented with a history of sleeping in daytime and
snoring at night is obstructive sleep apnea syndrome. Sleep apnea is known to be associated with
hypertension.
 Shift work insomnia is a circadian sleep disorder and it may respond to bright-light therapy.
Pulmonary hypertension
Definition  A mean pulmonary artery pressure> 25 mmHg at rest or 30 mmHg with
exercise.
Most common cause  Respiratory failure due to intrinsic pulmonary disease.
Light's criteria(suggests exudates) Causes of exudate Causes of transudate

 Pleural fluid protein / serum protein -Infection -Congestive heart failure
ratio is greater than 0.5 -Malignancy -Nephrotic syndrome
 Pleural fluid LDH / serum LDH ratio is -Connective tissue disease -Cirrhosis
greater than 0.6 -Chylothorax -Hypoalbuminemia
 Pleural fluid LDH is greater than two- -Pancreatitis -Urinothorax
thirds of the upper limit of normal -Postcardiotomy syndrome -Peritoneal dialysis
serum LDH value. -Drug-induced(e.g.amiodarone) -Early atelectasis
-Esophageal rupture
-Uremia
-Subdiaphragmatic abscess
Pneumoconiosis
 Pneumoconiosis results from inhalation of organic dust (e.g., asbestos, silica and metals).
 Asbestos exposure is associated with increased incidence of bronchogenic carcinoma and
mesotheliomas, especially if the patient smokes.
 Often, the disease has a prolonged latency period after exposure.
 Silicosis is associated with superinfection by Mycobacterium tuberculosis.
Hypersensitivity pneumonitis
Hypersensitivity pneumonitis occurs in persons who have an abnormal sensitivity to an organic agent.
Examples Farmer’s lung Caused by exposure to Actinomyces in moldy hay
Pigeon-Breeder’s lung Caused by exposure to animal protein in bird droppings
Treatment of pneumothorax
 A small pneumothorax in a symptomatic patient often requires no therapy.
 Pneumothorax >20% usually require treatment.
(a) Tube thoracostomy is the treatment of choice.
(b) Patients who have a history of recurrence may benefit from pleurodesis with intrapleural tetracycline.
 Patients who have a tension pneumothorax require immediate therapy with rapid needle
thoracocentesis immediately followed by the insertion of a chest tube.
First line therapy for TB Side effects

Isoniaziad Peripheral neuropathy, hepatitis, skin rash, mild CNS effects
Rifampicin Hepatitis, fever, skin rash, flu-like symptoms, GI upset, bleeding problem,
renal failure, orange colored secretion, Leukopenia and thrombocytopenia.
Pyrazinamide Hyperuricemia
Ethambutol Optic neuritis
Streptomycin 8th nerve damage, nephrotoxicity
Quick revision
 Adenocarcinoma of the lung is not associated with hypercalcemia.
 Small cell carcinoma does not cause clubbing.
 The most likely diagnosis of a patient admitted as a case of acute pancreatitis and developed progressive
respiratory distress within 12-48 hours is acute respiratory distress syndrome.
 Pulmonary arteriovenous malformations are found in 15%–30% of patients with hereditary
hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome.
 Klebsiella pneumoniae is associated with hemoptysis from necrotizing disease and "currant jelly"
sputum.
 Legionella is associated with gastrointestinal symptoms (abdominal pain, diarrhea) or CNS
symptoms (headache, confusion).
 Anaerobes are associated with Foul-Smelling sputum, "rotten eggs".
 Pneumocystis is associated with AIDS with <200 CD4 cells.
Sarcoidosis (non-caseating granuloma)
Grade CXR
Grade 0 Normal CXR
Grade 1 Lymph node enlargement
Grade 2A Lymph node enlargement + Diffuse pulmonary parenchymal disease
Grade 2B Diffuse pulmonary parenchymal disease
Grade 3 Pulmonary fibrosis (honeycombing)
-The most appropriate therapy for pulmonary sarcoidosis is glucocorticoids.
‫‪Notes‬‬
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Infectious diseases
The most common
Question Answer
1 Cause of an elevated lymphocyte count Viral infections
2 Infection transmitted person-to-person in Herpes gladiatorum caused by the herpes simplex
wrestlers virus
3 Causative organism in urinary tract infection, Escherichia coli
acute prostitis and epididymitis
4 Cause of secondary enuresis Urinary tract infection
5 Causative organism of Malignant external otitis Pseudomonas Aeruginosa
6 Opportunistic bacterial infection in AIDS Mycobacterium avium complex (MAC)
patients
7 Parasitic causative organism for subacute and Cryptosporidium parvum
chronic diarrhea in AIDS patients
8 Causes of intracranial masses in AIDS patients  Cerebral toxoplasmosis
 Primary brain lymphoma
9 Cause of dysphagia in AIDS patients Candidiasis
10 Cause of death in AIDS patients Pneumocystis pneumonia
11 Cause of Fever of unknown origin Infectious
12 Causative organism in catheter-related sepsis  staphylococcus aureus
 staphylococcus epidermidis
13 Sexually transmitted disease Genital warts
14 Bacterial sexually transmitted disease Chlamydia
15 Associated infection with Reiter’s syndrome Chlamydia
16 Bacterial causative organism of meningitis in Group B Streptococcus
neonates
17 Bacterial causative organism of meningitis in Streptococcus pneumoniae
children (1 month-3years)
18 Bacterial causative organism of meningitis in Neisseria meningitidis
children older than 3 years
19 Bacterial causative organism of meningitis in a Haemophilus influenzae
child with no history of immunization
20 Bacterial causative organism of meningitis in Streptococcus pneumoniae
adults
21 Bacterial causative organism of meningitis in Listeria monocytogenes
immunosuppressed
Causative organism Treatment

 Chlamydia trachomatis  Erythromycin/Tetracycline
 Neisseria gonorrhea  Ceftriaxone
 Trichomonas vaginalis  Metronidazole
 Bacterial vaginosis  Metronidazole
 Treponema pallidum  Penicillin
Sexually transmitted diseases treatment guidelines/Urethritis
History Intermittent urethral discharge accompanied by Dysuria+ acquiring a new sexual partner.
Treatment Azithromycin, 1 g orally as a single dose or Doxycycline, 100 mg orally twice a day for 7 days.
plus
Ceftriaxone (Rocephin), 250 mg intramuscularly or Cefixime 400mg orally in a single dose.
History Persisting of the same complaint without acquiring a new sexual partner.
Treatment Azithromycin, 500 mg orally once daily for 5 days, or Doxycycline, 100 mg orally twice daily
for 7 days.
plus
Metronidazole, 2 g orally as a single dose.
Mantoux tuberculin skin test

PPD 5 mm or greater consider PPD 10 mm or greater consider PPD 15 mm or greater consider
Positive in: Positive in: Positive in:
-HIV Infection -Health care workers -All persons (low risk for TB
-Recent Tuberculosis contact -New immigrant within last 5 disease)
-Immunosuppressed (e.g. HIV, years from developing nations
Prednisone >15 mg/day for >1 -Intravenous Drug Abuse
month, Immunosuppressant) -Children under age 4 years old,
-Apical fibronodular changes on or children/teens exposed to
Chest X-ray (old Tb scarring) or high risk adults
other findings on Chest X-ray -Malnutrition
-Diabetes Mellitus
-Cancer
-Chronic Kidney Disease
-Body weight >10% below Ideal
Weight
-Silicosis
-Tuberculosis endemic to region
-High risk living environments
(prison, Nursing Homes,
hospitals, homeless shelter)
Arbovirus infections which are transmitted to Arbovirus infections which are transmitted to
human by mosquito bites human by ticks
- Japanese encephalitis. - Louping ill.
- St. Louis encephalitis. - Crimean-Congo hemorrhagic fever.
- Murray valley encephalitis.
Characteristic features of HIV seroconversion illness
 Maculopapular rash, oral ulceration and generalized lymphadenopathy
 Aseptic meningitis
 Associated with a poorer prognosis
 Positive HIV P24 antigen
In Kaposi’s sarcoma occurring in AIDS patient

 There is preponderance in homosexual males.
 There is early involvement of lymph node and viscera.
 Visceral Kaposi’s sarcoma carries a worse prognosis than that confined to skin.
 A diffuse pneumonitis may occur.
 There is evidence of a genetic predisposition. There is a higher prevalence of HLA-DR5 in these
patients than in the general population.
 Human herpes virus 8 is involved in pathogenesis.
Schistosomiasis (Bilharziasis)
Type Hypersensitivity Treatment
reaction type
Causative Histopathology Involvement Shistosomal Praziquantel is
organism antigen-antibody effective against
-S.mansoni lateral spine Hepatic and complex all type of
-S.japonicum no spine intestinal Schistosomiasis
involvement
- S.haematobium the spine will be Obstructive
down uropathy and Type III
bladder cancer hypersensitivity
involvement
Antimicrobial treatment is advisable for Antimicrobial treatment is ineffective or

unnecessary
-Systemic forms of Salmonellosis ( Typhoid and - Salmonella gastroenteritis
Paratyphoid )
-Giardiasis - Shigella sonnei infection
- Severe Yersinia Infection
Mycoplasma pneumonia
Comment / Association Primary atypical pneumonia is caused by Mycoplasma and associated with dry
cough and bullous myringitis.
Clinical picture Both upper and lower respiratory infection
Gram stain Not seen( too minute)
Laboratory High titre of IgM cold agglutination
Treatment of choice Erythromycin
Disease Causative organism Presentation Treatment
Primary herpes infection -Fever -No effective therapy is
-Myalgia available, but acyclovir
-Cervical and inguinal is used to reduce
lymphadenopathy morbidity of the disease
-Exudative pharyngitis and decrease the
-Vesicles prior to ulcers incidence of
on the oral mucosa, the recurrences.
labia and cervix. They
are painful.
-Profuse vaginal
discharge
-Neutrophilia
Chancroid Haemophilus ducreyi -Doesn’t cause systemic -Management consists
symptoms of oral erythromycin.
-Leads to soft, non-
indurated, painful ulcer
Condyloma Human papilloma virus -Causes characteristic -Frequently used
large, soft, fleshy, therapies include
cauliflower-like cryosurgery, application
excrescences around of caustic agents,
the vulva, urethral electrodesiccation,
orifices, anus and surgical excision and
perineum. laser ablation.
-Topical podophyllin has
been used with some
success.
Lymphogranuloma Sexually transmitted -Fever -Azithromycin may be of
venereum infection caused by -Arthritis utility in treatment.
Chlamydia trachomatis -Pericarditis
-Painless papule
-Erythema nodosum
-Painful inguinal
lymphadenopathy and
suppurating
Chancre Syphilis is a sexually -The primary chancre -Penicillin G is the drug
transmitted infection usually begins as a of choice for all stages
caused by the single painless papule, of syphilis.
spirochete bacterium which rapidly becomes
Treponema pallidum eroded and usually, but
subspecies pallidum. not always, is indurated
with a characteristic
cartilaginous
consistency on
palpation of the edge
and base of the ulcer.
Viral hepatitis
Viral hepatitis
 The Most common type of hepatitis over the world is hepatitis-A virus.
 Most of hepatitis viruses are RNA except hepatitis-B virus.
 The most common cause of chronic hepatitis is hepatitis c-Virus.
 Transmission of hepatitis D can occur either via simultaneous infection with hepatitis B (coinfection) or
superimposed on chronic hepatitis B or hepatitis B carrier state (superinfection).
 Highest mortality rate in acute infection phase is related to hepatitis-E virus infection.
Hepatitis B virus:
 A hepadnavirus is partially double stranded small DNA virus consisting of genomic DNA, core protein
and surface protein.
 The core gene encodes for both core antigen and a cleavage product e antigen, which is a good marker
of active viral replication.
 Pre S –which is closely associated with the surface antigen viral envelope- has specific site for
hepatocytes.
 Interferon inhibits viral replication.
 Is required for hepatitis D infection.
Hepatitis B markers Indications

HBsAg -Indicates acute or chronic infection
-Used for blood bank screening
Anti-HBs -Indicates immunity (post-infection or post vaccination)
Anti-HBc -Useful because it may be the only serological marker of HBV infection during
the ‘’window period’’ in which HbsAg is disappearing, but Anti-HBs is not yet
detectable.
-Doesn’t distinguish between acute and chronic infection, and presence
doesn’t indicate immunity.
HBeAg -Indicates high degree of infectivity
Anti-HBe -Indicates resolution of acute infection
HCV markers Indications

- Hepatitis C virus (HCV) antibody enzyme -Initial assay for detecting hepatitis C virus
immunoassay
- Recombinant immunoblot assay -confirmatory test
- The quantitative HCV RNA polymerase chain reaction -Used to measure the amount of virus in the blood to
distinguish active from resolved HCV infection
-Before initiating Tumor necrosis factor inhibitors therapy, Patients should be screened for tuberculosis
and hepatitis B and C, because these drugs have been associated with an increased risk of infections.
- This class of agents includes monoclonal antibodies such as infliximab, adalimumab, certolizumab
pegol, and golimumab.
Treatment of urinary tract infection and pyelonephritis
 Uncomplicated lower UTI often respond to Trimethroprim/Sulfamethaxazole or quinolones
during a treatment course of 5-7 days.
 Prolonged antibiotic coverage may be required for recurrent or chronic UTIs (e.g.,
Nitrofurantoin).
 Acute Pyelonephritis requires broad-spectrum antibiotic coverage such as IV ampicillin and
gentamicin.
 Most cases of uncomplicated acute Pyelonephritis can be managed in the outpatient setting.
Fluoroquinolones, such as ciprofloxacin, are the preferred empiric antibiotic treatment for
outpatient treatment of Pyelonephritis.
 Urologist referral is necessary for patients who have anatomic obstructions because chronic
reflux can lead to renal failure.
Quick revision
Question Answer
The Best method to prevent plague Eradicate rodent
syphilis stages  Chancer (painless) is associated with
primary Syphilis.
 Diffuse rashes in palms and palms and
soles and Condylomata lata are associated
with Secondary Syphilis.
 Formation of gummata is associated with
Tertiary Syphilis.
The most important risk factor for developing a Prolonged use of the urinary catheter
catheter-associated UTI (CAUTI)
The best treatment for subacute and chronic Highly active antiretroviral therapy
diarrhea in AIDS patients
EPV is associated with o Nasogastric carcinoma
o Hodgkin lymphoma (Mixed cellularity)
Protocol for diagnosis and treatment of influenza Influenza should be diagnosed on the basis of
clinical signs and symptoms and should be treated
symptomatically
Protocol for diagnosis and treatment of dog bites Dog bites are a common medical problem. Timely
and copious irrigation with normal saline or
Ringer’s lactate will reduce the rate of infection
markedly. Cultures are usually not helpful unless
the wound appears infected.
The most likely type of pharyngitis in a patient Bacterial pharyngitis
presented with tender anterior cervical
lymphadenopathy and absence of cough
Pharmacology
Drug Comment
Amantadine Antiviral and Antiparkinsonism drug that can be used in both adults and
children for up to 8 weeks as a daily prophylaxis for influenza
Oseltamivir (Tami flu) Antiviral prophylactic drug for influenza, but it is not indicated in children
less than 13 years old
Imiquimod (aldara) FDA approved to treat external anogenital warts for patients more than
12 years of age
Trimethroprim/ The treatment of choice in Pneumocystis jiroveci which is common with
Sulfamethaxazole HIV positive patients
Suppressive therapy with; Reduces -but does not eliminate- the risk of transmission of herpes
 Acyclovir simplex virus (HSV) to sexual partners
 Valacyclovir
 Famciclovir
Isoniaziad Used as a TB prophylaxis
Laboratory markers and diagnostic methods

Question Answer
The most accurate laboratory test for syphilis Dark-Field microscopy
The most useful laboratory test for syphilis Venereal disease research laboratory (VDRL)
The most appropriate and the most common Ziehl-Neelsen stain
staining technique used to identify acid-fast
bacteria (e.g. Tuberculosis)
The most accurate test of herpes encephalitis Polymerase chain reaction (PCR)
The most important initial test on a genital Tzank preparation
ulcerative lesion
The most accurate test of genital or skin lesion Viral culture
The first laboratory marker that becomes abnormal Surface antigen
first after acquiring hepatitis B infection
The best indicatory serological marker of the need E-antigen
for treatment with antiviral medication in chronic
hepatitis B and the best indicator that pregnant
women will transmit infection to her child
The best correlation with an increased likelihood of Elevated PT
mortality in a patient with hepatitis
Disease EBV (Infectious mononucleosis)

Clinical picture Malaise, anorexia, fever, sore throat, few palatal petechiea,
cervical lymphadenopathy and splenomegaly.
Laboratory Lymphocytosis, agranulocytosis, and thrombocytopenia.
Most important initial test Peripheral blood smear shows atypical lymphocytes
Most important serum test Heterophile antibody
Indication of usage of corticosteroids in  Severe hemolytic anemia
management  Airway obstruction
‫‪Notes‬‬
Gastroenterology
The most common
Question Answer
1 Complication of biliary tract infections (Cholangitis and cholecystitis) Pyogenic liver abscesses
2 Biliary tract infections Polymicrobial
3 Cause of acute cholecystitis Obstruction of the cystic
duct by an impacted
gallstone
4 Cause of acute infectious diarrhea Viral (Norovirus, which
include Norwalk virus)
5 Bacterial diarrhea Campylobacter jejeni
6 Cause of infectious diarrhea in day care centers and urban poor areas Shigella
7 Cause of water-borne infectious diarrhea Giardia lamblia
8 Cause of diarrhea among hospitalized patients Pseudomembranous colitis
(Clostridium difficile colitis)
9 Upper GI bleeding Peptic ulcer disease
10 Cause of peptic ulcer disease Helicobacter pylori
11 Cause of lower GI bleeding Diverticulosis
12 Cause of chronic pancreatitis in adult Alcoholism
13 Cause of chronic pancreatitis in children Cystic fibrosis
14 Causes of acute pancreatitis  Gallstones
 Alcoholism
15 Type of pancreatic carcinoma Adenocarcinoma
16 Causative organism in Travelers’ diarrhea Escherichia coli
Esophageal tumors
 The most common type of esophageal cancer worldwide is Squamous-cell carcinoma and it is
mainly attributed to Tobacco and Alcohol.
 The most common type of esophageal cancer in USA, Europe and Australia is Adenocarcinoma
and it is mainly attributed to Barrett’s esophagus.
 The most common benign tumor of esophagus is leiomyoma.
Diagnostic and therapeutic tests

Disease Test
 Meconium ileus Gastrografin enema
 Intussusceptions Air enema
 Ogilive syndrome (paralytic ileus of the colon in old, immobilized people) Colonoscopy
 Obstructed biliary tract ERCP
Laboratory markers and diagnostic methods
Question Answer
 The best strategy for screening for acute pancreatitis Measurement of both
serum amylase and lipase
 The worst prognostic serological marker in Pancreatitis Low calcium
 The most appropriate preliminary diagnostic evaluation for o WBC count
inflammatory bowel disease o Platelet count
o Potassium level
o Erythrocyte
sedimentation
rate
 Diagnostic method for Spontaneous bacterial peritonitis Spontaneous bacterial
peritonitis is diagnosed if
the fluid contains
neutrophil at greater than
250 cells per mm³ fluid
 The most sensitive and specific laboratory test for Celiac Serum IgA tissue
disease transglutaminase
Antibody (TTG) antibodies
 The Gold standard confirmatory test for Celiac disease Endoscopy with Small
Bowel biopsy
 The best diagnostic test for neoplasms of esophagus and Endoscopy with biopsy
stomach
 The most appropriate histological stain for hemochromatosis Prussian blue stain
Primary biliary cirrhosis Primary sclerosing cholangitis

Gender Middle-Aged women Younger men
Associated diseases Autoimmune disorders (sjogren's Ulcerative colitis
syndrome, CREST, Rheumatoid
arthritis)
Labs -Cholestatic LFTs. -Cholestatic LFTs.
-positive Antimitochondrial - Positive p-ANCA.
antibodies.
-Elevated cholesterol and HDL.
-Elevated immunoglobulin M.
Affected ducts Intrahepatic only Both intra- and extra-hepatic
Radiological studies -Abdominal Ultrasonography, ERCP and PTC are diagnostic
computed tomography (CT) studies of choice: see multiple
scanning, or magnetic resonance areas of bead-like structuring and
imaging (MRI) are important to bead-like dilatations of Both
exclude biliary obstruction. intra- and extra-hepatic.
-There is absence of duct
narrowing on ERCP.
Zollinger-Ellison syndrome
 Definition of Gastrinoma Nonbeta islet cell tumor of the pancreas
 Epidemiological data In 20 to 60 percent of those with
Zollinger-Ellison syndrome the Gastrinoma is a component of
MEN type 1
 Genetics An autosomal dominant disorder
 The most sensitive and Secretin stimulation test
specific diagnostic test
Malabsorption
Disease Celiac disease Tropical sprue Whipple’s disease
(Due to bacterial (Tropheryma whipplei)
infection or toxins)
Diagnostic clues Iron deficiency anemia Diarrhea and -Polyarthritis
that doesn’t respond to megaloblastic anemia -Abnormal skin
oral Iron. several months after pigmentation
-Dermatitis travel to tropical -Lymphadenopathy
Herpetiformis is country.
pathognomonic.
Jejunal biopsy -Flat mucosa. May look very similar to PAS positive granule in
-Board or absent villi Celiac disease. macrophages.
(villous atrophy).
-Inflammation.
Treatment Gluten-free diet -Hydration. Trimethoprim-
-Sulfonamide or Sulfamethoxazole
tetracycline. (months to years)
-B12 and Folate
supplement.
Disease Alpha-1 antitrypsin deficiency Wilson's disease

Genetics autosomal codominant disorder autosomal recessive disorder
Best initial diagnostic test Iron study (Increased serum Iron A slit-lamp examination for
and Ferritin, and decreased Iron detecting Kayser-Fleischer ring.
binding capacity).
Other diagnostic test -Most accurate test: Liver biopsy -Most accurate test: An
-Confirmatory tests: Abdominal abnormally increased amount of
MRI and HFE (C282Y) gene copper excretion into urine after
testing. taking Penicillamine.
Treatment Phlebotomy Penicillamine
Hemochromatosis (Bronze diabetes)
Epidemiological data Tests
-Hereditary Hemochromatosis is the most common -Transferrin saturation and Ferritin tests: Standard
single-gene disease in Western populations. diagnostic measures for Hemochromatosis.
-Hereditary Hemochromatosis is the most common -Liver biopsy: Formerly, this was the only way to
of several "iron overload" diseases. confirm a diagnosis of Hemochromatosis, but now
it is less common and could be used to assess the
amount of iron in the liver and can help to diagnose
liver damage (scarring and cancer).
-Magnetic Resonance Imaging: a non-invasive and
accurate alternative to measure liver iron
concentrations
-Genetic analysis for mutation of the HEA gene: can
be used as a diagnostic tool and to screen
asymptomatic relatives.
 In persons with symptomatic Hemochromatosis, repeated phlebotomy, by removing excessive
iron stores, results in marked clinical improvement. Specifically, the liver and spleen decrease in
size, liver function improves, cardiac failure is reversed, skin pigmentation (“bronzing”)
diminishes, and survival rate increases.
 If phlebotomy is begun in the precirrhotic stage, liver cancer will not develop.
 For unknown reasons, there is no improvement in the Arthropathy or Hypogonadism.
Case Management
 The most important primary management in Fluid resuscitation
gastrointestinal bleeding
 Treatment of Pseudomembranous colitis
( Clostridium Difficile colitis) 1-Discontinue offending antibiotic.
2-Metronidazole is the first-line therapy. Oral
administration is best but can be given IV.
3-Vancomycin (given orally) is used for
patients who cannot tolerate metronidazole or
who do not improve.
 Most useful prophylactic drug in Travelers’  Bismuth subsalicylate (Pepto-Bismol)

diarrhea  Antibiotics and Antimotiloity drugs are
not used frequently, but
fluoroquinolones are the antibiotics of
choice.
Definitions
Term Meaning
Mucosa-associated Most MALT lymphoma is related to H.Pylori infection. Studies have shown
lymphoid tissue (MALT) that eradication of the infection results in regression of such lymphoma.
This treatment involves a prolonged course of antibiotic therapy aimed at
eliminating the bacteria. MALT lymphoma can progress to diffuse, large, B
cell lymphomas. Combination chemotherapy has been used in treatment of
the diffuse aggressive lymphoma that arises from MALT.
Mallory–Weiss syndrome Tear in the mucosa at the junction of the stomach and esophagus
Boerhaave’s syndrome Tear in full thickness (rupture of the esophageal wall)
Melanosis coli  Brown to black leopard spotting of the colonic mucosa.
 A benign condition resulting from abuse of anthraquinone laxatives
such as cascara, senna, or aloe.
 The condition resolves with discontinuation of the medication.
Bacterial food poisoning syndromes

Organism Incubation period Source of infection (examples)
 Staphylococcus aureus 2-6 hours Meat and dairy handlers
 Brucella cereus 2-8 hours Reheated fried rice
 Clostridium perfringens 8-14 hours Reheated meats, poultry and
legumes
 Salmonella 24-48 hours Foods (e.g., raw eggs, meat,
poultry and seafood)
 Pathogenic Escherichia coli 1-3 days Food (e.g., raw meat, milk or
dairy products and raw fruits and
vegetables) and Contaminated
water.
-Personal contact
 Vibrio cholerae 1-3 days Fecally contaminated water
 Shigella 1-3 days Fecal-oral spread
 Clostridium botulinum 1-2 days Canned foods
 Clostridium difficile During or within 4 weeks of Antibiotic-associated
discontinuing antibiotic
therapy
 Campylobacter 2-4 days Food (e.g., raw or undercooked
meat, poultry and milk) and
Contaminated water.
-Person to person transmission
via the fecal-oral route
-Contact with infected animals
FAMILIAL POLYPOSIS SYNDROMES
Syndrome Symptoms/Signs Malignant potential
Familial adenomatous polyposis >100 polyps in colon and rectum Yes
Gardner syndrome Polyposis, desmoids tumors, osteomas, Yes
sebaceous cysts
Turcot syndrome Polyposis, medulloblastoma/glioma Yes
Peutz-Jeghers syndrome Multiple hamartomatous polyps, melanotic Small
pigmentation of skin and mucous
membranes
Quick revision
Question Answer
 Abdominal colicky pain with vomiting could  Bowel obstruction
be associated with  Cholelithiasis
 Nephrolithiasis
 Gastroparesis could be associated with Longstanding diabetes mellitus
 Causes of increase level of amylase, include  Bowel obstruction
 Pancreatitis
 Mumps
 The most likely diagnosis of an elderly patient Pancreatic cancer
presented with painless jaundice and
depressed mood
Esophageal Variceal Bleeding

-Definition Bleeding from esophageal vessels that have increased pressure secondary to
portal hypertension. Variceal bleeding presents as hematemesis or postural
hypotension in a patient with known or suspected portal hypertension.
-Treatment -Maintain perfusion pressure with normal saline and blood as needed.
-Replace clotting factors with fresh frozen plasma.
-Somatostatin (Octreotide).
-Beta blockers.
-Endoscopic sclerotherapy or banding.
-Balloon tamponade.
‫‪Notes‬‬
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Hematology and Oncology
The most common
Question Answer
1 Presenting symptom of Hodgkin lymphoma Painless lymphadenopathy
2 Red cell enzymopathy G6PD enzyme deficiency
3 Cause of death in patients with hemophilia A Intracranial hemorrhage
4 Utilized method for detection of Hemoglobinopathies Hemoglobin electrophoresis
5 Cause of spinal cord compression in people with cancer Metastasis to the spine
6 Presenting symptom of multiple myeloma Bone pain
7 Cause of disseminated intravascular coagulation Pregnancy and obstetric complications
8 Form of acute myelogenous leukemia t(8;21)
9 Cause of abnormal bleeding Thrombocytopenia
10 Cause of thrombocytopenia Increased peripheral destruction
11 Cause of isolated thrombocytopenia Idiopathic (Immune) thrombocytopenic
purpura
12 Form of porphyria porphyria cutanea tarda
13 Inherited bleeding disorder von Willebrand’s disease
Plasma cell neoplasm

-The most common plasma cell neoplasm is multiple myeloma.
-The most common Immunoglobulin class produced in plasma cell diseases is IgG.
-The monoclonal immunoglobulin in Waldenstrom's macroglobulinemia is of the IgM class. Because IgM
is so large (it circulates as a pentamer), it is restricted to the bloodstream and in high concentrations tend
to cause hyperviscosity of the blood.
Classifications Oncologic Emergencies

Metabolic 1. Hypercalcemia (most common)
2. Tumor Lysis Syndrome
3. SIADH (Syndrome of Inappropriate Antidiuretic Syndrome)
Neurologic 1. Spinal Cord Compression
2. Brain metastases/ Increased Intracranial pressure
Cardiovascular 1. Malignant Pericardial Effusion
2. Superior Vena Cava Syndrome
Hematologic 1. Hyperviscosity due to Dysproteinemia
2. Hyperleukocytosis
3. DIC (disseminated intravascular coagulation)
Infectious 1. Neutropenic fever
2. Septic shock
How to monitor anticoagulation therapy?
Type Unfractionated Heparin Low molecular weight Warfarin
heparin
Monitor Activated partial Anti factor Xa Prothrombin time and
thromboplastin time International
normalized ratio
Antidote Protamine sulphate Protamine sulphate Vitamin K
The cause of Thrombocytopenia in the following conditions is correctly assigned in each case:
condition causes
Acute leukemia Marrow aplasia; there is hormonal suppression of normal cells by
leukemic cells and mechanical ‘crowding out ‘in the bone marrow.
Systemic lupus erythematosus Platelet antibodies; may be an initial manifestation.
Gram-negative septicemia Induces consumption by immune complexes, complement activation
and direct toxemia.
Massive transfusion Dilution.
Splenomegaly- from any cause- Sequestration.
Side effects of chemotherapy

-Cisplatin Nephrotoxicity
-Bleomycin Pulmonary fibrosis
-Vincristine Neurotoxicity
-Doxorubicin Cardiotoxicity
-Tamoxifen Carcinogenic
G6PD enzyme deficiency

Inheritance X-linked recessive
pathophysiology RBCs are unable to generate reduced glutathione, which protect
hemoglobin from oxidative denaturation.
Example of Drugs Likely to Induce  Antimalarials (e.g., Primaquine, quinine)
Hemolytic Anemia in G6PD  Sulfonamides
Deficiency  Nitrofurantoin
 Dapsone
Diagnosis and findings of non-hematopoietic diseases in the bone marrow
Disease type Disease Bone marrow findings
Bacterial Tuberculosis -Aspiration shows acid-fast bacilli
-Biopsy shows epithelioid
granulomas
Unknown Sarcoidosis Epithelioid granulomas
(Noncaseating)
Parasitic Kala-azar Organism-laden macrophages
(Visceral leishmaniasis) (Donovan bodies)
Fungal Aspergillosis Hyphae with areas of necrosis
Storage disease; Gaucher’s disease Characteristic histiocytic cells
Accumulation of with a fibrillar inclusion material
glucocerebrosidases that has an onion-skin pattern
Storage disease; Niemann-Pick disease Histiocytic cells with foamy
Accumulation of sphingomyelin cytoplasm containing lipids and
phospholipids sea-blue histiocytes
Metabolic Cystinosis Histiocytic cells laden with
birefringent cystine crystals
Familial Osteopetrosis Compacted intramedullary
(Albers-Schonberg or marble osseous tissue with very little
bone disease) hematopoietic tissue
Immunoglobulin Amyloidosis Marrow replacement by pale
acidophilic material that stains
positive with Congo red
Megaloblastic Anemia (MCV>100)

-Results from decrease DNA synthesis with normal RNA/Protein synthesis.
-Pathognomonic blood smear Hypersegmented neutrophil
Type Vitamin B12 deficiency Folic acid deficiency
Most common cause Pernicious anemia Dietary deficiency
Presentation Neurologic signs= Peripheral No Neurologic signs
neuropathy, paraesthesia,
decrease balance and position
sense, worse in legs.
Diagnosis -Increase serum methylmalonic -Normal serum methylmalonic
acid level acid level
-Increase homocysteine levels -Increase homocysteine levels
Treatment Vitamin B12 high-dose oral Oral folic acid supplementation
therapy proven to be equivalent
to parenteral
Quick points
Question Answer
 The most likely diagnosis of a middle-aged male Polycythemia Vera
presented with pruritis after showering, plethora of
face and palms and hepatosplenomegaly
 The most probable diagnosis of a patient develops a Selective IgA deficiency
severe case of hives ten minutes after transfusion
 Prolonged PT indicates A defect in extrinsic factors
 Therapeutic range of INR 2-3
 Biochemical evidence of lead toxicity includes  Elevation of blood lead
 An increase in free erythrocyte
protoporphyrin
 Proto-oncogenes function  Control cell growth and
differentiation.
 They are transiently
upregulated by growth factors.
 They are normal cellular genes
that associated with the
development of a wide variety
of human tumors.
 Triad of Plummer Vinson syndrome -Iron deficiency anemia
-Esophageal web
-Glossitis
 Triad of Felty's syndrome -Rheumatoid arthritis
-Splenomegaly
-Neutropenia
 Drug-induced thrombocytopenia -May be caused by intravenous heparin
-Usually respond to withdrawal of the
drug
-Has a better prognosis than drug-
induced agranulocytosis
 Differences between Hemolytic uremic syndrome and Hemolytic uremic syndrome is similar
Thrombotic thrombocytopenic purpura to Thrombotic thrombocytopenic
purpura.
But;
 HUS occurs in children.
 HUS is localized to the kidney.
 HUS does not contain
neurologic abnormalities.
 Before splenoectomy, sickle cell patient should receive  H.Influenza vaccine
the following vaccines:  Meningococcal vaccine
 Pneumococcal vaccine
Disease ALL AML CML CLL Hairy cells Myelofibrosis
Age 3-7 All ages 50 years 70 years 50 years 50 years
Presentation -Fever -Fever -Anorexia -Asymptomatic -Organomegaly -Massive
-Petechiea -Petechiea -Fever then Organomegaly
-Ecchymoses -Ecchymoses -Splenomegaly -Insidious few
-CNS infiltrate -Lymphadenopathy -Diaphoresis symptoms
-Pallor -Splenomegaly -Early satiety -Organomegaly
-Pallor -Arthritis -pallor
-Bone -Fatigue
tenderness -Lymphadenopathy
-Dyspnea
-Dizziness
-Slurred
speech
-Diplopia
Labs -Leukocytosis -Anemia -Positive -Anemia -Pancytopenia -Tear drop cells
-Anemia -Thrombocytopenia Philadelphia -Thrombocytopenia -Characteristic -Hypercellular
-Thrombocytopenia -Auer rods in chromosome -Lymphocytosis hairy cell bone marrow
- Lymphoblastosis Myeloblasts in myeloid morphology in -Increased
- Terminal -Decreased stem cells ; bone marrow Leukocyte
deoxynucleotidyl Leukocyte alkaline t(9;22) alkaline
transferase phosphatase levels -Decreased phosphatase
Leukocyte levels
alkaline
phosphatase
levels
Sickle cell disease

Genetics What is the definition of acute How to differentiate between
chest syndrome? Aplastic crisis and Hemolytic
crisis?
An autosomal recessive trait Acute chest syndrome: a vaso-
which results from a single amino occlusive crisis of the pulmonary Aplastic Low reticulocyte
acid substitution of valine for vasculature commonly seen in crisis count
glutamic acid at the number 6 patients with sickle cell anemia. Hemolytic High reticulocyte
position in the B chain. -Presentation: crisis count
 Fever
 Chest pain
 Shortness of breath
 Hypoxia
 Chest infiltrate
 Hemoglobinopathies and conditions causing hemolysis can cause HbA1c measurements to be
falsely low.
 In patients with sickle cell trait there is an increased incidence of urinary tract infections.
Hematology pharmacology
Case Treatment
Thrombotic thrombocytopenic purpura Emergency large-volume plasma exchange
Bleeding caused by thrombolytic agents Cryoprecipitate
The most appropriate prophylaxis against DVT (e.g. Low molecular weight heparin (enoxaprin) and
after total knee replacement) adjusted dose warfain
The least expensive and best absorbed form of iron Ferrous sulphate
therapy, yielding the most elemental iron absorbed
per gram administered.
The adult dosage is typically 300mg/day and is
gradually increased to 900mg/day if tolerated.
Disease Hodgkin's lymphoma Non-Hodgkin lymphoma

Histology Presence of Reed Sternberg cell Absence of Reed Sternberg cell
Types/Association  Lymphocyte depleted Has a bad prognosis and
(Worst prognosis) associated with HIV infection
 Lymphocyte rich
(Good prognosis)
 Mixed
(Associated with EBV infection)
 Nodular sclerosing
(Most common)
Type of lymphoma Renal complications

Hodgkin’s lymphoma -Minimal change glomerulonephritis
Non-Hodgkin’s lymphoma -Secondary membranous glomerulonephritis
Types of cells in peripheral smears Possible cause

Howel -Jolly bodies Sickle cell disease
Target cell Thalassemia
Heinz bodies and bite cells G6PD enzyme deficiency
Types of anemia Microcytic anemia Normocytic anemia Macrocytic anemia

( MCV<80 fl) (MCV= 80-100 fl) ( MCV>100 fl)
Examples -Iron deficiency -Renal disease -Folate deficiency
-Thalassemia -Vitamin B12 deficiency
-Sideroblastic
‫‪Notes‬‬
Nephrology
The most common
Question Answer
1 Form of glomerulonephritis IgA nephropathy (Berger’s disease)
2 Cause of glomerular origin hematuria IgA nephropathy (Berger’s disease)
3 Cause of acute interstitial nephritis Drug-related hypersensitivity reaction
4 Cause of nephritic syndrome post-streptococcal glomerulonephritis
5 Cause of end stage renal disease Diabetes mellitus
6 Cause of anemia of chronic disease Chronic renal failure
7 Cause of hypermagnesemia Chronic renal failure
Indications for urgent dialysis

-Uremic complications: pericarditis with effusion, and encephalopathy.
-Pulmonary edema not responding to medical treatment.
-Significant hyperkalemia ( >7 ) with evidence of ECG changes and resistance to medical therapy
-Rapidly rising urea and creatinine.
-worsening severe metabolic acidosis (pH < 7.2 or base excess < -10).
- Intoxication: e.g. methanol and ethylene glycol.
Nephrotic syndrome
-Minimal change disease is the most common cause of Nephrotic syndrome in children.
-Focal segmental glomerulosclerosis is the most common cause of Nephrotic syndrome in adults.
Medical Treatment Features of Nephrotic syndrome
-Loop Diuretics (e.g. Furosemide) -Hyponatremia
-ACE Inhibitor (e.g. Enalapril (Vasotec)) -Hypoalbuminemia (Serum albumin<2.5gm/dl)
-Corticosteroids -Proteinuria > 3.5 gm/ day
-Avoid nephrotoxins (e.g. NSAIDs) -Hyperlipidemia: is present in vast majority of patients
-Maintain Blood Pressure less than 130/80 with Nephrotic syndrome and typically is characterized
-Control Hyperlipidemia by a relatively selective increase in LDL. There is
evidence of accelerated atherosclerosis in these
patients.
-Renal vein thrombosis
-Orbital edema
-Thromboembolism
-Infections; due to loss of immunoglobulins in urine
-Coagulability; due to loss of Antithrombin3 in urine
Diuretics used to treat Calcium disorders

Disorder Drug Action
Hypocalcemia Thiazide Lower urinary calcium and prevent urolithiasis
Hypercalcemia Furosemide Inhibit calcium reabsorption
Causes of Hyperkalemia
 Renal failure -The most common cause of hyperkalemia genuinely is renal failure.
 Drug-induced
Beta blocker K+ sparing diuretics ( Spironolactone)

NSAIDs Cyclosporine
ACEI, ARBs Heparin
Digitalis Succinylcholine chloride
(Suxamethonium)
 Rhabdomyolysis
Causes
Alcoholism
Hypothyroidism
Drugs
 Destruction of RBCs
 Potassium supplements
 Diabetes mellitus type1
 Addison’s disease
Sodium imbalance correction complication

 An overly rapid increase in serum sodium concentration may produce central pontine
demyelination.
 Excessively rapid correction of hypernatremia can lead to cerebral edema.
Disease Chronic renal failure DKA Acute pancreatitis

ABG -Metabolic acidosis -Metabolic Acidosis -Metabolic alkalosis
Electrolytes disturbance -Hypocalcemia -Hypokalemia -Hypocalcemia
-Hyponatremia
-Hyperkalemia
-Hyperphosphatemia
Diuretics Thiazide Loops diuretics Spironolactone

Effect -Hypokalemia -Hypokalemia -Hyperkalemia
-Hyperlipidemia -Hyperlipidemia -Hyponatremia
-Hyperuricemia -Hyperuricemia
-Hyponatremia -Hyponatremia
-Hyperglycemia -Hypomagnesaemia
-Hypercalcemia -Hypocalcaemia
Pharmacology
 The most appropriate initial step in a patient presented with hyperkalemia is administration
of IV Calcium gluconate. While administration of IV bicarbonate, (Insulin and dextrose) and
salbutamol are a temporizing measures. Administering oral sodium polystryrease sulfonate
(Kayexalate) is an effective way of permanently removing potassium from the body over a
period of 4-10 hours. Initiating urgent hemodialysis is indicated only if the medical
management of hyperkalemia fails.
 The most likely anti-acid responsible for hypophosphatemia is Aluminum Hydroxide.
 Gadolinium contrast can cause nephrogenic systemic fibrosis if used in patients with
advanced kidney disease. Contrast has rapid effect on kidney faster than nephrotoxic drugs (which
may appear after 5-10 doses).
 The most appropriate initial management of hypercalcemia of malignancy includes fluid replacement
with normal saline to correct the volume depletion that is invariably present and to enhance renal
calcium excretion. The mainstay of treatment for the hypercalcemia of malignancy is intravenous
pamidronate.
 Patients with chronic kidney disease (CKD) and those at risk for CKD because of conditions such as
hypertension and diabetes have an increased risk of deterioration in renal function from NSAID use.
 Although there appears to be an increased risk of myositis in patients with renal failure treated with
lipid-lowering agents, the risk is relatively low (far below 20 percent). Combination therapy (e.g., an
HMG-CoA reductase inhibitor and a fibric acid derivative) should be used with caution.
Acidosis Alkalosis
 Right shift in oxygen-hemoglobin dissociation  Left shift in oxygen-hemoglobin dissociation
curve diminishes affinity of hemoglobin for curve increases affinity of hemoglobin for
oxygen, thus there is increasing in oxygen oxygen, thus there is decreasing in oxygen
delivery to tissues. delivery to tissues.
Refeeding syndrome: the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients
receiving artificial refeeding (whether enterally or parenterally).
- The most classic electrolyte abnormality: hypophosphatemia
Syndromes lead to hypokalemic metabolic alkalosis and is chloride resistant (high urinary chloride)
Syndrome Bartter’s Syndrome Gitelman’s Syndrome Liddle’s Syndrome
Genetics Autosomal recessive Autosomal recessive Autosomal dominant
disorder disorder disorder
Resembling Furosemide (Lasix) Hydrochlorothiazide Hyperaldosteronism
Nitrogen accumulation diseases

Renal failure Hepatic failure
When the kidneys are unable to excrete urea, Amino acid catabolism is decreased, and so even
Ammonia may be used for the net synthesis of normal protein intake may be deleterious.
nonessential amino acids; thus, the need for
nonessential nitrogen is reduced.
Acute interstitial nephritis
-Most common cause An adverse reaction to a drug.
-Most common drug-related cause Antibiotics, especially Penicillins, Cephalosporins, and sulfonamides.
-Treatment Corticosteroids may be useful for treating this condition.
Acid-Base balance
 The main complication of gastroectomy is metabolic alkalosis.
 After prolonged excessive vomiting the patient will suffer from metabolic alkalosis.
 The most likely electrolyte imbalance associated with respiratory alkalosis is hypokalemia.
 High anion gap metabolic acidosis with calcium oxalate crystals in urine is highly indicative of
ingestion of ethylene glycol.
 Aspirin overdose: early respiratory alkalosis, then metabolic acidosis with high anion gap.
 Isopropanol poisoning is characterized by ketosis without acidosis.
Compensation for Metabolic Acid/Base disorders

Primary disorder Expected compensation
Metabolic acidosis Expected PCO2 = (1.5 × [HCO3-]) + 8 (range: +/- 2)
Metabolic alkalosis Expected pCO2 = 0.7 [HCO3] + 20 (range: +/- 5)
 Anion Gap = Na - (Cl + HCO3-)

 Delta Gap = Anion Gap - 12 (normal anion gap)
Type of cast Association

 Red cell Glomerulonephritis
 WBC Pyelonephritis
 Eosinophil Acute (allergic) interstitial nephritis
 Hyaline Dehydration
 Broad, Waxy Chronic renal failure
 Granular “Muddy-Brown" Acute tubular necrosis
CAUSES OF ACUTE RENAL FAILURE

Prerenal Renal Postrenal
 Hypoperfusion  Interstitial disease  Urinary tract obstruction.
secondary to (interstitial nephritis or
hypovolemia, blood loss, acute tubular necrosis).
dehydration.  Glomerular disease.
 Maldistribution, as in  Renovascular disease.
sepsis or liver disease
and low cardiac output.
‫‪Notes‬‬
Endocrinology
The most common
Question Answer
1 Cause of Charcot foot Diabetes mellitus
2 Form of diabetic neuropathy Distal symmetric polyneuropathy
3 Cause of hypoglycemia in diabetic patients Insulin overdose
4 Cause of death in diabetic patients Coronary heart disease
5 Cause of hypothyroidism Hashimoto's thyroiditis
6 Cause of hyperthyroidism Grave’s disease
7 Etiologies of hypercalcemia Primary hyperparathyroidism and malignancy
8 Presentation of primary hyperparathyroidism Asymptomatic hypercalcemia
9 Cause of primary hyperparathyroidism Parathyroid adenoma
10 Cause of secondary hyperparathyroidism Chronic renal failure
11 Cause of hypoparathyroidism Surgical removal of the parathyroid glands
during a neck procedure
12 Reproductive disorders in men  Gynecomastia
 Hypogonadism
Laboratory marker
Question Answer
 The most accurate measure of severity of DKA Serum bicarbonate
 First initial sign to detect diabetic nephropathy Microalbuminurea
 The major form of thyroid hormone in the blood which has a T4
longer half-life
 The most active (Potent) thyroid hormone T3
 The most appropriate laboratory tests to confirm congenital T4 and TSH
hypothyroidism
 The most initial appropriate test for menstrual irregularities TSH
 The best test used to monitor response to thyroxin replacement TSH
therapy
 Subacute thyroiditis is associated with High ESR
 The most appropriate test to screen for late-onset male Total testosterone
hypogonadism
 The most appropriate initial test to rule out adrenal insufficiency Morning serum cortisol
Disease Cushing’s syndrome Acromegaly

Laboratory diagnostic  Initial screening test(he most  Screening test/The most
tests specific diagnostic test): 24- sensitive laboratory test: IGF1
hour urinary free cortisol (Somatomedin C)
level  Confirmatory test/the most
 Another excellent screening specific laboratory test: Oral
test(Confirmatory test): Low glucose suppression test.
dose Dexamethasone
suppression test
Presentation Disease Aldosterone Cortisol Renin
Hypertension with Primary  High  Normal  Low
Hypokalemia Aldosteronism
(Conn’s syndrome)
Secondary  High  Normal  High
Aldosteronism
Cushing's Disease  Low  High  Low
Hypotension with Adrenal  Low  Low  High
Hyperkalemia insufficiency
(Addison disease)
Adrenal gland
part Primary regulatory Anatomy Secretory products
control
The adrenal cortex: Renin-Angiotensin Zona glomerulosa Aldosterone
the outer part of the ACTH, hypothalamic Zona fasciculata Cortisol, Sex hormone
gland and comes from CRH
mesoderm ACTH, hypothalamic Zona reticularis Sex hormone
CRH (e.g., Androgen)
The adrenal medulla: Preganglionic Medulla Catecholamines
the inner part of the sympathetic fibers (Chromaffin cells) (Epinephrine, and
gland and comes from Norepinephrine)
neural crest
Diabetic ketoacidosis (DKA) is  Serum PH<7.3

best defined as:  Blood glucose of more than 11mmol/L
 Positive serum acetone
-The most accurate measure of the severity of DKA is serum Bicarbonate. If the Bicarbonate level is low,
the anion gap is increased.
Multiple Endocrine Neoplasia syndromes

-Autosomal dominant inheritance with incomplete penetrance.
-Type 1 (Wermer’s syndrome)  Familial Primary Hyperparathyroidism
 Pituitary Adenoma
 Pancreatic islet tumors
-Type 2a (Sipple’s syndrome)  Medullary thyroid carcinoma
 Pheochromocytoma
 Hyperparathyroidism
-Type 2b  Mucosal neuromas
 Medullary thyroid carcinoma
 Marfanoid body habitus
 Pheochromocytoma
Diabetes Insipidus The syndrome of inappropriate antidiuretic
(Lack of Antidiuretic hormone) hormone secretion (SIADH)
 Hypernatremia  Hyponatremia
 Dehydration  Normal volume status (euvolemic)
Addison’s disease
Most common cause worldwide Tuberculosis
Most common cause of in the western Autoimmune disease
world
Presentation  weight loss
 Hyperpigmentation
 Hypotension
 Fatigue
 Loss of appetite
 Depression
Laboratory tests  High ACTH
 Low cortisol
 Low Na
 High K
 High Ca
Common autoimmune thyroid diseases

Disease Graves disease Hashimoto disease
(Diffuse toxic goiter)
Clinical presentation An autoimmune cause of An autoimmune cause of
hyperthyroidism, with heat (usually) hypothyroidism, with
intolerance, palpitation, cold intolerance, rubbery goiter,
tachycardia, tremor and facial puffiness, and sparse,
opthalmopathy. coarse hair.
Endocrinology pharmacology
 Metformin is the only hypoglycemic agent shown to reduce mortality rates in patients with
type 2 diabetes mellitus.
 Type of acidosis after usage of metformin is lactic acidosis, which is uncommon side effect.
 Metformin is contraindicated in patients with renal insufficiency.
 Sulfonylurea initially acts by increase secretion of insulin by beta cells.
 Pioglitazone can cause fluid retention and therefore would not be a good choice for a patient
with cardiomyopathy.
 In a patient receiving Levothyroxine, a low TSH level usually indicates over replacement.
 Exogenous testosterone leads to Infertility.
 Abrupt cessation of exogenous glucocorticoids leads to adrenal insufficiency.
Quick revision
Diagnostic criteria for Diabetes Mellitus
 Hemoglobin A1c level ≥ 6.5%
 Fasting plasma glucose level ≥ 126mg/dL
 Random glucose level ≥ 200 mg/dL in a
patient with symptoms of diabetes
 2-hour oral glucose tolerance test value ≥
200 mg/dL
Risk factors that increase diabetic

nephropathy  Poor glucose control
 Long standing diabetes mellitus
 Hypertension
 Hypercholesterolemia
 Renal disease
 Pregnancy
Pharmacologic Treatment  Metformin is well tolerated and there is

recommendations for Prediabetes good data to show it helps prevent type 2
diabetes mellitus in high-risk patients.
 Pioglitazone has been shown to slow the
progression from Prediabetes to diabetes,
but it has more side effects and is more
expensive than metformin.
Diabetes mellitus complications
 Macrovascular Brain, heart and
complication peripheral
vasculature
 Microvascular Retina, kidneys and
complication nerves
The following drugs have been associated  Bendrofluazide (Thiazide diuretics)

with impairment of glucose tolerance  Estrogen
 Prednisolone (corticosteroids)
Why diabetic patients should avoid beta Because they could mask hypoglycemic features.
blockers?
Diabetes Medications
Drug class Mechanism of action Drug name
Biguanide -Sensitizes peripheral tissues to Metformin
insulin and increases glucose
uptake.
-Decreases hepatic glucose
production
Insulin secretagogue -Stimulates insulin release from  Sulfonylureas:
beta cells by causing K channel  Glyburide
closure leads to depolarization  Gliclazide
and Ca mediated insulin  Glimepiride
release.  Non-Sulfonylureas:
 Repaglinide
 Nateglinide
Insulin sensitizers -Sensitizes peripheral tissues to  Rosiglitazone
(Thiazolidinedione) insulin and increases glucose  Pioglitazone
uptake.
-Decreases free fatty acid
release from adipose tissue.
-Bind to nuclear receptor.
Alpha-glucosidase inhibitors -Decreases carbohydrates Acarbose
absorption from GI by inhibiting
brush border alpha-glucosidase.
Dipeptidyl peptidase-4 -Inhibits degradation of Sitagliptin (Januvia)
inhibitors endogenous antihyperglycemic
incretin hormones.
-Incretin hormones stimulate
insulin secretion, inhibit
glucagon release and delay
gastric emptying.
Laboratory findings in thyroid dysfunction

Condition T4 RTU(T3 UPTAKE) FREE T4 Index TSH
Primary Decreased Decreased Decreased Increased
hypothyroid
Secondary Decreased Decreased Decreased Decreased
hypothyroid
Primary Increased Increased Increased Decreased
hyperthyroid
Drug class Drug name Indications Contraindications Side effects
Antithyroid  Propylthiouracil Hyperthyroidism -Hypersensitivity -Nausea, vomiting
agent -Renal and liver -Rash
failure -Drug-induced
hepatitis
-Agranulocytosis
 Methimazole -Pregnancy Drug-induced

-Lactation hepatitis
Thyroid Levothyroxine Hypothyroidism Symptoms of
hormone hyperthyroidism
‫‪Notes‬‬
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Rheumatology
Quick revision
Question Answer
The most common joint involved in Pseudgout Knee
The most common cause of acute monoarthritis in elderly Acute synovitis (Pseudgout)
The first line treatment of Rheumatoid Arthritis according to Methotrexate
latest guidelines
Advantages of omega-3 and omega-6 fatty acids in patients with Substitution of omega-3 fatty acids found in
rheumatoid arthritis certain fish oils or dietary omega-6 essential
fatty acids has been shown to provide
symptomatic improvement in patients with
rheumatoid arthritis, but has not been shown to
alter the disease process
The most typical characteristic for polymyalgia rheumatica A dramatic response to corticosteroids
“Pencil-in-cup” appearance on x-ray is associated with Psoriatic arthritis
Systemic lupus erythematosus malar rash description In Systemic lupus erythematosus, the first
criterion is a malar rash characterized by an
Erythema over the cheeks and nasal bridge (but
sparing the nasolabial folds, which is in contrast
to the rash of dermatomyositis). It lasts from
days to weeks and is occasionally painful or
pruritic.
Heart condition that is commonly associated with Pericarditis
connective tissue diseases (.e.g. Rheumatoid arthritis, SLE,
Mixed connective tissue disease (sharp’s syndrome), Still’s
disease)
The strongest marker to exclude discoid lupus from systemic Presence of Anti-double-stranded DNA
lupus erythematosus
In an acute lupus flare  Complement level drops
 Anti-double stranded DNA levels rise
The most common cause of secondary Raynaud’s phenomenon Scleroderma
Amyloidosis definition Long-standing rheumatoid arthritis is currently
one of the most common causes of systemic
amyloidosis. This may give rise to a complex
clinical picture resulting from amyloid deposition
in the skin, kidneys, tongue gastrointestinal tract
and peripheral nerves.
Patient may present with carpal tunnel
syndrome, skin plaques in the axillary region,
nephrotic syndrome, hepatosplenomegaly,
macroglossia and chronic diarrhea with
malabsorption.
Osteoarthritis Rheumatoid Arthritis

Bouchard’s nodes: Bony swelling at the proximal Boutonniere deformity: Characterized by fixed flexion of
interphalangeal joints of the fingers. proximal interphalangeal joints and extension of the
distal interphalangeal joints.
Heberden’s nodes: Bony swellings at the distal Swan neck deformity: Characterized by hyperextension
interphalangeal joints of the fingers. of the proximal interphalangeal joints and fixed flexion
of the distal interphalangeal joints.
Disease Fibromyalgia Polymyositis Polymyalgia Rheumatica
Classic age/Sex Young adult women Female aged 40-60 years Female> age 50 years
Location Various Proximal muscles Pectoral and pelvic girdles,
and neck
ESR Normal Elevated Markedly elevated
(often>100)
EMG/biopsy Normal Abnormal Normal
Findings -Anxiety -Elevated CPK -Associated with temporal
-Stress -Higher risk of cancer arteritis
-Insomnia
-Point tenderness over
affected muscles
Treatment -Antidepressants Steroids Steroids
-NSAIDs
-Pregabalin
-Rest
Inflammatory Myopathies
Characterized by:
-Slowly progressive, symmetric proximal muscle weakness.
-Elevated muscle enzyme (Creatine Kinase and aldolase).
-Biopsy: Lymphocytic inflammation.
-20% are associated with other autoimmune diseases.
-10% are associated with malignancies.
Disease Dermatomyositis Polymyositis
Characteristics -Myopathy -Myopathy
-Dermatologic manifestation -No rash
(Heliotrope rashes, Gottron’s -No calcinosis
papules, Shawl (or V-) sign,
Periungual telangiectasia,...)
-Calcinosis
Treatment -Prednisolone
-Methotrexate
-Intravenous immunoglobulin
-Azathioprine
-Cyclophosphamide
-Rituximab
Drug induced lupus

Description Common drugs that may induce lupus
 Often mild  Hydralazine
 Reversible after drug cessation  Procainamide
 ANA may persist for years  Quinidine
 Isoniazid
 Chlorpromazine
 Methyldopa
Disease Gout (Monosodium urate) Pseudgout (Calcium
pyrophosphate
deposition disease)
History Male, binge drinking, acute onset Hemochromatosis or
afterward. Hyperparathyroidism.
Physical Findings The first big toe is affected. The wrists and knees are
affected.
x-ray features: Chondrocalcinosis
Crystal shape Needle shaped Rhomboid
Crystal Birefringence Negative Positive
‫‪Notes‬‬
Neuroscience
The most common
Question Answer
1 Presentation in multiple sclerosis Blurred vision
2 Complication of seventh cranial nerve palsy Corneal ulceration
3 Neurological deficit of untreated bacterial meningitis Eight cranial nerve deficit or deafness
4 Cause of aphasia Cerebrovascular disease
5 Cause of non-traumatic subarachnoid hemorrhage Rupture of a cerebral aneurysm
6 Causative organism of encephalitis Herpes
7 Toxin associated with seizures Alcohol
8 Initial manifestation of increasing intracranial pressure Change of level of consciousness
in victim of head trauma
9 Cause of intracerebral hemorrhage Hypertension
10 Sites for hypertensive hemorrhage Caudate and Putamen
11 Headache in adults Tension headaches
12 Forms of syncope Neurally mediated or Vasovagal types
13 Form of diabetic neuropathy Distal symmetric polyneuropathy
14 Cause of seizure in elderly Ischemia-stroke, transient ischemic attack
15 Pattern of multiple sclerosis Relapsing-remitting category
16 Cause of death after severe head injury Elevated intracranial pressure

Question Answer
 The most accurate test (the most sensitive and MRI
specific investigation) for Multiple sclerosis
 The most accurate test for Herpes encephalitis PCR
 The most well-validated tests for confirming brain An electroencephalogram (EEG)
death
Neuroscience pharmacology
 The most important step in management of a Parkinson disease patient presented with psychosis
is antidopaminergic (e.g., Clozapine: antipsychotic drug with fewest extra-pyramidal effects).
 The best initial therapy for bacterial meningitis is Ceftriaxone and vancomycin.
 Initial therapy of cluster headache includes inhalation of 100% oxygen for 15 minutes.
 Agent of choice for treatment of trigeminal neuralgia is Carbamazepine.
 Agent of choice for treatment of giant cell arteritis is Corticosteroids.
 Aspirin, Acetaminophen, Ergotamine and caffeine combination, Sumatriptan, Amitriptyline,
Calcium channel blockers and Beta-blockers are antimigrainous agents that have been used for
treatment and prophylaxis for different types of headache (Tension, Migraine and Cluster).
Quick revision
Question Answer
o Brown-Séquard Brown-Séquard syndrome is an incomplete spinal cord lesion
syndrome definition characterized by Ipsilateral spastic paralysis below the level of the
lesion and Abnormal reflexes (lateral corticospinal tracts), Ipsilateral
loss of tactile discrimination, vibratory, and position sensation below
the level of the lesion (Posterior (dorsal) column-medial lemniscus
pathway) and Contralateral loss of crude touch, pain and temperature
sensation usually occurs 2-3 segments below the level of the lesion (
lateral spinothalamic tracts).
o Features of Pons lesion A lesion within Pons cause ipsilateral facial droop with contralateral
hemiparesis.
o Type of tremor in Resting tremor
Parkinson's disease
o The most dangerous  Dysautonomia
complication of  Involvement of the respiratory muscle
o Guillain-Barre
syndrome
o The most probable Atherosclerosis
pathophysiological
mechanism for stroke in
a patient with Diabetes
mellitus and
Hypertension
o Indicators of basal skull  Battle's sign - is ecchymosis of the mastoid process of the
fracture temporal bone
 Raccoon eyes - is periorbital ecchymosis i.e. "black eyes"
 CSF rhinorrhea
 Petrous fracture- is bleeding from the external auditory meatus or
CSF otorrhea
 Subconjunctival hemorrhage
Hallmark of Amyotrophic The presence of upper and lower motor neuron signs
Lateral Sclerosis
Transient ischemic attack Reversible neurologic deficit that lasts from a few minutes to no more
definition than24 hours.
Signs of Meningeal Irritation

Nuchal Rigidity Spinal Rigidity Kernig's Signs Brudzinski's Sign
Involuntary muscle -Erector spinae muscle Hamstring muscle pain Involuntary hip and
spasm limits passive spasm limits spine when examiner lifts the knees flexion due to
neck flexion. movement. supine patient’s passive neck flexion.
-Opisthotonos (rigid extended leg.
arched back) may occur.
parkinsonism
Causes Treatment
Drug-induced -Reserpine Co-careldopaThe first medication used to

-Tetrabenazine ( Contains L-
increase dopaminergic activity in
-Phenothiazine dopa ) the basal ganglia
Toxins -Methyl-Phenyl- Benztropine Used for anticholinergic side
Tetrahydropyridine effects
-Manganese Selegiline An MAO inhibitor
-Carbon monoxide ( potentiates dopamine )
Viral encephalitis Japanese B Amantadine An antiviral drug ( also
Neural damage -Supra nuclear palsy potentiates dopamine ) used as
-Shy Drager syndrome a second line drug
-Cerebral tumor Apomorphine Used for on-off fluctuations
-Wilson's disease Benzhexol Indicated when there is mild
-Huntington's disease parkinsonism or when there is
-Neurosyphilis oculogyric crisis
Ropinirole A non-ergot dopamine agonist
that binds the dopamine
receptors D3 and D2
Locked-in syndrome
Definition Possible causes
-A condition in which a patient is aware but cannot -Amyotrophic lateral sclerosis
move or communicate verbally due to complete -Medication overdose
paralysis of nearly all voluntary muscles in the body -Multiple sclerosis
except for the eyes. -Damage to nerve cells, particularly destruction of
the myelin sheath, caused by diseases (e.g. central
pontine myelinolysis)
-A stroke or brain hemorrhage, usually of the
basilar artery
-Traumatic brain injury
Wernicke’s encephalopathy Thiamine (vitamin b1) deficiency.

Presentation Triad of:
1- Opthalmoplegia ,Nystagmus
2- Ataxia (wide based gait)
3 -Confusion
Consider it in Alcoholics
Treatment IV thiamine
Complications korsakoff's psychosis , death
Glasgow Coma Scale
 Eye Opening Spontaneous: 4
To speech: 3
To pain: 2
No Response: 1
 Best Verbal Response Oriented: 5
Confused: 4
Inappropriate words: 3
Incomprehensible sounds: 2
No Response: 1
 Best Motor Response Obeys: 6
Localizes : 5
Withdraws to pain: 4
Abnormal Flexion (Decorticate Posturing): 3
Abnormal Extension (Decerebrate Posturing): 2
No Response: 1
Idiopathic intracranial hypertension (IIH)= Benign intracranial hypertension (BIH)= Pseudotumor cerebri
(PTC)
Definition A neurological disorder that is characterized by increased
intracranial pressure in the absence of a tumor or other diseases.
Presentation -Headache (Most common symptom)
-Nausea and vomiting
-pulsatile tinnitus
-Double vision
- swelling of the optic disc in the eye (If there is no treatment)
Most commonly occur in Women aged 20-40, especially those with obesity.
Most common cranial nerve palsy 6th
Complication Vision loss
Treatment Some respond to medication (with the drug acetazolamide), but
others require surgery to relieve the pressure.
Neurocysticercosis
Causative organism Taenia solium ( Pork tapeworm )
Most presenting feature Focal seizures
Cause of seizures Localized inflammation that accompanies their degeneration in the
cerebral cortex when calcified cysts occur
Diagnostic tool CT or MRI may show granulomatous cysts
Confirmatory diagnostic method An enzyme-linked immunotransfer blot
Treatment Albendazole
Type of headache Clinical features
Classic migraine -Associated with a prodromal aura, which is usually a transient visual, motor, or sensory
phenomenon.
-Headache is typically unilateral and pulsating.
-Headache is preceded by a prodrome.
-Headache may persist for 1-2 days.
-Pain may vary from mild to severe.
-Some prodromal symptoms may be severe and produce transient hemiplegia, aphasia, or
hemisensory deficits.
Common migraine -Not associated with a prodromal aura.
-Pain is unilateral or bilateral and is usually intense.
-Pain usually affects the eyes, frontal regions, and temples.
-Headache typically lasts for a day or longer.
-Both types of migraines tend to begin in adolescence or early adulthood and may be
associated with vomiting.
Cluster -Recur over periods of weeks to months, followed by periods with no headache.
-Cluster headaches are most common in middle-aged men with leonine facies and a
history of heavy smoking or drinking.
-Each headache typically lasts 30 minutes to 2 hours.
-Pain is unilateral and occurs around the eyes.
-Horner syndrome may present.
-Headache may be associated with nasal congestion/rhinorrhea.
-Pain radiates to the ipsilateral neck or jaw.
-Ipsilateral conjunctival injection and ipsilateral facial redness may be seen.
-Alcohol is a common trigger.
Tension -Characterized by a feeling of tightness (band-like), pressure and constriction.
-These headaches are often associated with stressors.
-Pain is commonly suboccipital and nonthrobbing.
-Pain slowly increases and may last for many hours or even days.
-Associated with prolonged positioning of the head and neck.
Depression headache -Often worse in the morning.
-Frequently associated with other manifestations of depression.
Trigeminal neuralgia -Appears in the middle to later part of life and is more common in women.
-Characterized by momentary, sudden, lancinating facial pain.
-Pain typically arises on one side of the mouth and then radiates to the eye, ear, and/or
nostril of the ipsilateral side.
-Pain may be precipitated by touch, movement, breezes, or eating.
-Attacks tend to increase in frequency.
-Neurologic examination is usually normal unless an underlying disease is present (e.g.,
multiple sclerosis).
Giant cell arteritis -Granulomatous medium-and large-artery vasculitis that affects persons older than 50
(Temporal arteritis) years of age.
-The disease may coexist with polymyalgia rheumatica (characterized by aching
extremities, stiffness, fatigue, and headache).
-Symptoms include those of claudication (pain, pallor, paresthesias, and pulselessness),
headache, visual changes and scalp tenderness.
-Common sites of claudication include jaw (indicating temporal arteritis), tongue and
extremities.
-Visual changes include blurring, ptosis, diplopia and partial or complete blindness (due to
ophthalmic vessel arteritis).
-New onset of headache in an elderly person with fever and anemia suggests the
diagnosis.
-Tenderness over the affected portion of the temporal artery may be elicited, and this
area should undergo biopsy immediately because of the risk of blindness.
Type of motor neuron lesion UMN LMN
Muscle bulk (Wasting) No Yes
Muscle tone Increases Decreases
Muscle power Paralysis affects movements of Individual muscle is paralyzed
group of muscle
Deep tendon reflexes  Exaggerated  Diminished
 Clonus may be present  No clonus
Superficial reflexes Lost Not affected
Plantar response An extensor plantar response Flexor response
(upgoing) (downgoing)
Fasciculation Absent Present
Normal pressure hydrocephalus

 Mild impairment of memory typically develops gradually over weeks or months, accompanied by
mental and physical slowness.
 The condition progress insidiously to severe dementia.
 Patient develops an unsteady gait and urinary incontinence, but there are no signs of increased
intracranial pressure.
Pituitary tumor
Most common type of pituitary tumor Prolactinoma
Classical physical finding bitemporal hemianopia
Medical treatment Dopamine agonist (e.g. bromocriptine)
Sodium correction
Condition Comment
 Chronic hypernatremia  Correction of chronic hypernatremia should be accomplished
gradually over 48-72 hours to prevent neurologic damage
secondary to cerebral edema.
 Chronic hyponatremia  Correction of chronic hyponatremia should be accomplished
slowly >27 hours to prevent central pontine myelinosis
(Paraparesis/quadriparesis, dysarthria and coma).
 Guillain-Barré syndrome  Myasthenia gravis

-Manifests with ascending paralysis (first the lower, -Characterized by fluctuating muscle weakness that
then the upper extremities are involved) and usually begins in the ocular muscles, resulting in
results from a chronic inflammatory response diplopia and ptosis. The disorder is due to impaired
leading to demyelination of peripheral nerves. It is cholinergic transmission at the neuromuscular
often preceded by an upper respiratory tract junction.
infection.
In myasthenia gravis
 Antibodies to acetylcholine receptors are present.
 Antibodies to striated muscle are associated with the presence of a thymoma.
 Tendon and pupillary reflexes are normal.
 Large doses of anticholinesterases may precipitate a cholinergic crisis (presence of cholinergic
features of sweating, salivation, diarrhea and miosis.
The most common primary central nervous system tumors

 The most common CNS tumor Metastatic
 The most common CNS primary tumor in adults Glioblastoma
 The most common CNS primary tumor in pediatrics Medulloblastoma
Acute head injury

Acute epidural hematoma produces a biconvex, Acute subdural hematoma produces a crescent
lens-shaped collection shaped hematoma
-Initial management includes hyperventilation, diuretics and fluid restriction.
-If there is a midline shift or anisocoria (inequality of pupils), patient must undergo surgical evacuation.
Type of aphasia Association

Wernicke's aphasia Receptive, fluent aphasia. The lesion is posterior to the central sulcus.
Broca's aphasia Expressive, nonfluent aphasia. The lesion is anterior to the central sulcus.
Conduction aphasia Disturbance in repetition. Pathology involves the connections between
Wernike's and Broca's areas.
Global aphasia Disturbance in all areas of language function. Often associated with a
right hemiparesis.
‫‪Notes‬‬
Pediatrics
The most common
Question Answer
1 Congenital heart disease Ventricular septal defect
2 Acynotic heart defect Ventricular septal defect
3 Cause of cyanotic heart defect Tetralogy of Fallot
4 Cause of cyanotic heart defect in neonates Transposion of great vessels
5 Pathologic arrhythmia in pediatric age group Supraventricular tachycardia
6 Cause of recurrent abdominal pain in children 4–16 years of age Functional abdominal pain
7 Organic cause for recurrent abdominal pain in children Urinary tract infection
8 Cause of urinary tract infection in infant Escherichia coli
9 Vertically transmitted infection (TORCH) Cytomegalovirus
10 Pathogen in occult bacteremia in children under 3 years of age Streptococcus pneumoniae
11 Organism causing otitis media in children Streptococcus pneumoniae
12 Causative organism in gastroenteritis Rotavirus
13 Bacterial organism in gastroenteritis Campylobacter jejeni
14 Infectious cause of pediatric vaginal discharge Group A streptococcus
15 Cause of seizures in neonate Hypoxic-Ischemic encephalopathy
16 Cause of convulsions in young children Febrile convulsions
17 Neuromuscular disorder of childhood Duchenne muscular dystrophy
18 Cause of death in Duchene muscular dystrophy Respiratory failure
19 Cause of arrest in children Respiratory
20 Reason of admitting a newborn to a level 2 or 3 NICU Respiratory distress
21 Cause of bronchoectasois Cystic fibrosis
22 Cause of neonatal mortality Prematurity
23 Cause of death during the first 12 months of life Sudden infant death syndrome
24 Morbidity seen among patients with Juvenile rheumatoid arthritis Uveitis
25 Type of elevated bilirubin Unconjugated bilirubin
26 Cause of rectal bleeding Milk protein colitis
27 Cause of infant botulism Ingestion of Clostridium botulinum
spores in honey
28 Malformation of the head and neck Unilateral cleft lip
29 Type of karyotype abnormality associated with infertility Klinefelter’s Syndrome
30 Etiology of purpura Trauma
31 Form of vasculitis Henoch-Schonlein purpura
32 Cause of readmission of the infants Jaundice
33 Organism involved in lung abscess Staphylococcus aureus
34 Complication of lung abscess Intracavitary hemorrhage
35 Cause of endobronchial obstruction Foreign body aspiration
36 Lysosomal storage disease Gaucher disease
37 Form of spinal muscular atrophy Werdnig-Hoffman disease (SMA type 1)
38 Congenital cause of hydrocephalus Neural tube defects
Mental retardation Short stature

Most common cause  Down's syndrome  Familial
Second most common cause  Fragile-X syndrome  Constitutional
Most common tumors
 Most common tumor Acute lymphoblastic leukemia
 Most common childhood acute lymphoblastic leukemia, which Immature B cell type
has a good prognosis and can be treated with mild therapies
 Most common soft tissue tumor Rhabdomyosarcoma
 Most common intra-abdominal tumor Neuroblastoma
 Most common renal tumor Wilm's tumor
 Most common Benign laryngeal tumor Recurrent respiratory papillomatosis
 Most common primary intraocular malignancy Retinoblastoma
 Most common Optic nerve tumor Optic glioma
 Most common Optic chiasm tumor Craniopharyngioma
Respiratory
 The most common cause of croup (steeple sign) is parainfluenza virus type 1 and 2, the RSV.
 The most common cause of epiglottitis (positive thumbprint sign) is HIB.
 Whooping cough is caused by Bordetella pertussis (Butterfly pattern).
 The most common cause of Bronchiolitis is Respiratory syncytial virus.
 The most common cause of pneumonia overall is Streptococcus pneumoniae.
 The most common cause of acute infectious pharyngitis is streptococcus pyogenes.
Congenital adrenal hyperplasia

General Characteristics Labs Diagnosis Treatment
-Autosomal recessive -Serum electrolytes: increased -Medically:
disease -Hyponatremia 17-Hydroxyprogesterone -Rehydration
-The most common type -Hypochloremia -Correct Hypoglycemia
(90%) is due to 21- -Hyperkalemia -Cortisol and
hydroxylase deficiency. -Hypoglycemia Mineralcorticoids
-Adrenal labs: -Surgically:
-Low cortisol -Early correction of female
-Low Aldosterone genital abnormality.
-High renin
-Sex hormone
abnormalities depend on
enzyme deficiency:
-Virilizing if 21-Hydroxylase
or 11-Hydroxylase
-Testosterone increased in
girls
-Androstenedione
increased in girls and boys
Causes of Conjunctivitis in neonates

At first day of life  Chemical
2-7 days  Neisseria gonorrhea
More than 7 days  Chlamydia
More than 3 weeks  Herpes
Vaccination
Vaccine type Examples

Live, attenuated  MMR
 Chicken pox vaccine
 Oral polio vaccine
 Rotavirus vaccine
 BCG vaccine
 Influenza (nasal spray)
Inactivated/Killed  Injectable Polio vaccine
 Hepatitis A
 Rabies
Toxoid (inactivated toxin)  Diphtheria, tetanus (part of DTaP combined immunization)
Subunit/conjugate  Hepatitis B
 Influenza (injection)
 Haemophilus influenza type b (Hib)
 Pertussis (part of DTaP combined immunization)
 Pneumococcal
 Meningococcal
 Human papillomavirus (HPV)
Oral Polio vaccine Injectable Polio vaccine

 Live-attenuated  Inactivated
 Lifelong immunity  Required booster dose every 4-5 years
 Local gut and systemic immunity  Minimal gut immunity
 May cause paralytic disease  No risk of paralytic disease
varicella vaccine
-Two doses of varicella vaccine are recommended for all children unless they are immunocompromised, in which
case they should not be immunized against varicella, or with other live-virus vaccines.
- Shingles is evidence of prior varicella infection and is a reason not to vaccinate with varicella vaccine.
Hepatitis b vaccine
 Vaccination of baby against hepatitis B must be at birth, 2 month and 6 month. If the mother had
hepatitis B +ve, the child should be vaccinated and given immunoglobulin in the first 24 hours. If the
status of mother is unknown, we must vaccinate the child and ask for mother HbsAg.
Timing
Question Answer
Anterior fontanel closes between 9-18 months
Posterior fontanels close by The end of second month
Food introduction for infants should be at 4-6 months of age
Retinoblastoma
-Retinoblastoma is the most common primary intraocular malignancy of children.
-The mode of inheritance of hereditary form of retinoblastoma is Autosomal dominant.
-Familial cases of retinoblastoma have predisposition to second malignancies, particularly osteosarcoma of femur.
-A small percentage of retinoblastoma cases are caused by deletions in the region of chromosome 13 (13q14)
containing the RB1 gene.
Management of status epilepticus

First line Benzodiazepines (lorazepam, and Diazepam)
Second line Phenytoin/ Fosphenytoin
Third line Phenobarbital
Fourth line Neuromuscular blocking agent (Succinylcholine, Vecuronium or pancuronium) for intubation
and general anaesthesia (Midazolam or Propofol).
Disease Abnormal gene product

Osteogenesis imperfecta Procollagen type 1
Ehlers-danlos syndrome Procollagen type 3
Marfan’s syndrome Fibrillin
Mucopolysaccharidosis Mucopolysaccharides
Achondroplasia Fibroblast growth factor (FGF) receptor 3
Component Breast milk Cow milk

Protein
Fat
Carbohydrates
Albumin-Iron-Immunoglobulin
Casein (40%)
Whey (60%)
Calories Same
-Breast feeding minimizes the incidence of:
 Gynecological tumors: Breast, Ovarian and uterine cancers
 Infantile colic
 Skin allergy
 Asthma
 Constipation
 Obesity
 Diabetes mellitus type1
Cystic fibrosis
 Genetics and mode of -The CFTR gene is located on the long (q) arm of chromosome 7.
inheritance -Autosomal recessive.
 Best diagnostic method Sweat chloride test
 Most common cause of death Respiratory failure
 Most common causative Pseudomonas Aeruginosa
organism in cystic fibrosis-
related infection
 Pathognomonic hepatic lesion Focal biliary cirrhosis
Down’s syndrome (Trisomy 21)

Most Most Most Specific Most common Most Most common Diagnostic method during
common common heart defect hematologic common leukemia pregnancy for Down's
risk factor type disorder cancer syndrome
Advanced Non- atrioventricular Polycythemia Leukemia -Younger than Laboratory Radiological
Maternal dysjunction septal defect one year: acute tests investigations
Age over (Endocardial non- -Decreased Increased
35 at cushion defect) lymphoblastic AFP nuchal
delivery leukemia. -Decreased translucency
-Older than 3 estriol in
years: acute -Increased ultrasound.
lymphoblastic B-HCG
leukemia. -Increased
Inhibin
-Increased
PAPPA-A
The diagnostic criteria for Kawasaki disease

 Fever for 5 days or more
plus
4 out of 5 of
 Polymorphous rash
 Bilateral (non purulent) conjunctival injection
 Mucous membrane changes, e.g. reddened or dry cracked lips, strawberry tongue, diffuse redness of oral
or pharyngeal mucosa
 Peripheral changes, e.g. erythema of the palms or soles, edema of the hands or feet, and in convalescence
desquamation
 Cervical lymphadenopathy (> 15 mm diameter, usually unilateral, single, non purulent and painful)
Fragile x syndrome characteristics Fetal alcohol syndrome characteristics

 Long and narrow face  Growth deficiency
 Large ears  Micrognathia
 Large testes  Thin upper lip
 low intelligence quotient  Microcephaly
 Developmental disability  Short palpebral fissures
 Autism  Not meeting developmental milestones
 Seizures
 Attention deficit hyperactivity disorder
Pediatrics cardiology
Question Answer
Cyanotic congenital heart diseases
 Truncus arteriosus
 Transposition of great arteries
 Tricuspid valve abnormalities
 Tetralogy of fallot
 Total anomalous pulmonary venous
connection
Transposion of great vessels shape “Egg – shaped silhouette” appearance

Tetralogy of fallot shape “Boot-shaped” appearance
Complications of ventricular septal defect
Small -Infective endocarditis
-Pulmonary hypertension
Large -Right ventricular
hypertrophy
-Right sided heart failure
Long-term complication -Shunt reversal
of unrepaired large VSD
Atrial septal defect findings  ASD has a fixed, widely split S2 with a right
ventricular heave and a systolic ejection
murmur. There may also be a mid-Diastolic
rumble.
 The commonest presentation is asymptomatic
murmur.
 ASD is associated with hypertrophic right
atrium.
Tetralogy of Fallot components  Subpulmonary stenosis (most important
determinant of clinical severity and
symptomatology)
 VSD
 Overriding aorta
 Right ventricular hypertrophy
Treatment of hyper- cyanotic spell of Tetralogy of Fallot  Propranol
 Phenylephrine
 Knee-Chest position
 Fluid
 Morphine
 NaHCO3
Contraindication of Tetralogy of Fallot  Isoprenaline is inappropriate treatment,
because it reduces systemic vascular resistance
and thus increases the right to left shunt.
Quick revision
Question Answer
Effective management options in children with nocturnal  An enuresis alarm
enuresis (Bed wetting)  Desmopressin acetate
 Imipramin
 Behavioral modification
Newborns weight changes  10% decrease in the first days then return to
B.W in the end of first week
 B.W doubles in 4-6 months
 B.W triples in 12 months
Associated metabolic alterations in pyloric stenosis  Hypokalemia
 Hypochloremia
 Dehydration
 Alkalosis
The most serious complication of perinatal asphyxia Hypoxic ischemic encephalopathy (HIE)
The most suggestive feature of congestive heart failure Diaphoresis (Profuse perspiration) with feeding
in an infant
Neisseria gonorrhea isolated from a child on vaginal Sexual abuse
culture is definitive evidence of
Transient hypogammaglobulinemia definition Transient hypogammaglobulinemia is due to exhaustion
of maternally supplied IgG – the only ones that cross
placenta. Patient presented with recurrent infection
after 4-6 months of birth.
Infantile colic definition A benign condition when the baby presented with a
history of crying for 3 hours mainly at evening at 2nd
and 3rd month of age. Management includes
reassurance without medication.
Shigella dysentariae infection is associated with Febrile convulsions
Sharp delta waves on the EEG will be indicative of Seizure activity
Holding breath spells is a known precipitant cause of Generalized convulsions
Blood vessels in the Vitreous is an indicator of Prolonged oxygen exposure in preterm neonates
Recommendations of phototherapy in jaundiced
newborn Total serum bilirubin Timing
≥ 15 25-48 hours old
≥ 18 49-72 hours old
≥ 20 older than 72 hours old
Breast Milk Jaundice definition -Jaundice in exclusively breast fed infants – in the first
few days of life – is due to deprivation of caloric intake,
increasing the breast feeding to more than 10 times per
day is recommended in these patients.
Pathological jaundice definition 1. Occurs in the first day of life.
2. Or serum bilirubin level increases by >5 mg/dl
per day
or if > 17 mg/dl
or if associated with serious illness.
Fractures related to child abuse
Fracture Causes/Association
 Spiral fractures of the humerus and femur Abuse in children below 3 years of age
 Epiphyseal-Metaphyseal “Bucket fractures” Shaking or jerking of the child’s limbs and it is
highly diagnostic of physical abuse in an infant
 Posterior rib fractures Squeezing of the chest
-To roll out shaken baby syndrome by performing an ophthalmologic exam for retinal hemorrhage and a non-
contrast CT for subdural hematoma.
‫‪Notes‬‬
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Obstetrics and Gynecology
The most common
Question Answer
1 Benign neoplasm of the female genital tract Uterine leiomyoma (Fibroids)
2 Gynecological malignancy Endometrial cancer
3 Histological type of endometrial cancer Endometrioid adenocarcinoma
4 Cause of puerperital pyrexia Endometritis
5 Cause of maternal death / cause of post partum death Postpartum hemorrhage
6 Cause of post partum hemorrhage Uterine atony
7 Genital neoplasms occurring in childhood Ovarian cysts and neoplasm
8 Ovarian neoplasm during childhood Germ cell tumors
9 Type of invasive cancer of cervix Squamous cell carcinoma
10 Vaginal infection in women of reproductive age Bacterial vaginosis
11 Immunologic disorder in women of childbearing age Idiopathic thrombocytopenic purpura
12 Recognized precipitating factor in spontaneous abortion Chromosomal abnormalities
13 Causative organism of mastitis and breast abscess occur in Staphylococcus aureus
lactating mother
14 Protraction or arrest disorder Cephalopelvic disproportion
15 Medical complication of pregnancy is Pyelonephritis
16 Hormonal cause of hirsutism in young women Excess androgen production by
noncycling ovaries
Uses of Magnesium sulphate Uses of Ergotamine

-Treatment of preterm labor -Treatment of acute migraine attacks
-prevention of seizures in patients -Prevent post-partum hemorrhage
with preeclampsia
Advantage of mediolateral episiotomy Advantages of median episiotomy

-Less likely to cause a fourth degree extension -Easier surgical repair of the episiotomy
-Improved healing of the episiotomy
-Less blood loss
-Less pain
Tamoxifen
Advantages Disadvantage
-Hormonal adjunctive treatment has proven -Paradoxical tamoxifen-induced endometrial
benefits in pre and post menopausal women. hyperplasia.
-Anti-estrogen used for treatment of breast cancer,
and tumors that express estrogen/progesterone
receptors respond better to it.
-It results in better survival regardless of tumor
staging or grading.
Finding Association
Early deceleration Head compression
Variable deceleration Umbilical cord compression
Late deceleration Uteroplacental insufficiency/Fetal hypoxia
(Most serious and dangerous)
Placenta previa Placenta abruption

rd
-Painless vaginal bleeding >28 weeks -Painful 3 trimester vaginal bleeding + contraction
- (+/- Fetal distress)
-The most appropriate diagnostic method for both Placenta previa and Placenta abruption is
transabdominal ultrasound.
Ultrasonographic Prenatal assessment of gestational age

-First-trimester crown-rump length is the best parameter for determining gestational age.
-In the second and third trimesters, estimation of gestational age is accomplished by measuring the
biparietal diameter, head circumference, abdominal circumference, and femur length.
polycystic ovarian syndrome

Labs Complications Treatment
-High LH Women with polycystic ovarian -Metformin and clomiphene
-High FSH syndrome are at great risk of alone or in combination are first-
-High Androgen developing; line agents for ovulation
-High Estrogen 1-Type 2 Diabetes induction.
-Low progesterone 2-Dyslipidemia -Spironolactone will improve
3-Endometrial cancer hirsutism and menstrual
irregularities.
Gestational Diabetes
Fetal complication Maternal complication
1-Fetal Macrosomia; operative delivery risk (Cesarean 1-Longterm risk of developing Diabetes Mellitus: 50%
section), birth Trauma risk and shoulder dystocia. 2-Hypertension
2-Metabolic; hypoglycemia, hypocalcaemia and 3-Preeclampsia
hypoglycemia. 4-Ceserean Section
3-Hypothermia
4-Hyperbilirubinemia
5-Caudal regression syndrome
6-Premature birth
7-Respiratory distress syndrome
8-Hematologic; Polycythemia, hyperviscosity,
thrombocytopenia and low iron stores.
9-Obesity during childhood
10-Cardiomyopathy
11-Congenital anomalies
12-Perinatal asphyxia
The initial evaluation for chronic pelvic pain
 Urinalysis and culture
 Cervical swabs for gonorrhea and Chlamydia
 CBC
 Erythrocyte sedimentation rate
 B-hCG level
 pelvic Ultrasonography
Effective management of Hot flashes

 Estrogen replacement therapy.
 Escitalopram(Cipralex): an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class
Infertility in women
o The most likely cause of infertility in a normally menstruating woman under the age of 30 is Pelvic
inflammatory disease.
o The most likely cause of infertility in a normally menstruating woman over the age of 30 without
a history of Pelvic inflammatory disease is endometriosis.
o The most likely cause for infertility in a woman under 30 with abnormal menstruation is
polycystic ovary syndrome.
o The most common preventable cause of infertility overall is Pelvic inflammatory disease.
Ectopic pregnancy
 The most common site is fallopian tube mostly in the Ampulla.
 The 3 most common presenting complaints are: amenorrhea, abdominal pain and vaginal
bleeding.
 The most appropriate initial step for diagnosis is serum HCG.
 Culdocentesis is a diagnostic procedure.
 Laparoscopy is a confirmatory procedure.
Gestational age
 The recommended time to screen for gestational diabetes is 24-28 weeks.
 Amniotic Fluids reach it maximum Volume (1 liter) at 34-36 weeks.
 The definition of post-term pregnancy is a pregnancy that has reached 42 weeks gestation.
Lichen sclerosus
-Definition A chronic, progressive, inflammatory skin condition found in the anogenital region. It is
characterized by intense vulvar itching.
-Treatment High-potency topical corticosteroids
Pregnancy and pharmacology
Drugs Comments
NSAIDs (e.g. Naproxen)  Most appropriate choice of management of primary dysmenorrhea.
Combined Aspirin and heparin  Used to treat pregnant women with antiphospholipid syndrome.
Low molecular weight heparin  The preferred anticoagulant for venous thrombosis during
pregnancy.
Atenolol and Propranolol  Associated with intrauterine growth retardation when used for
prolonged periods during pregnancy.
Alpha-Methyldopa, Hydralazine, and  Most commonly treatment used for gestational hypertension.
Labetalol
Methotrexate  An absolute contraindicated drug in breast feeding.
(Cytotoxic drugs)
Trimethroprim/Sulfamethaxazole  Effective treatment for acute uncomplicated cystitis in women.
Nitrofurantoin  Effective treatment for acute uncomplicated cystitis in women who
have allergy to sulfa drugs.
Doxycycline  The drug of choice for treatment of Chlamydia trachomatis
infection in non-pregnant women.
Azithromycin  The drug of choice for treatment of Chlamydia trachomatis
infection in pregnant women
Acyclovir (Oral)  Considered first-line treatment for a female patient presented with
multiple painful genital vesicles.
Danazole  The treatment of choice of endometriosis.
Clomiphen  Anti-estrogen used to increase FSH levels and induced ovulation in
infertile patients.
Insulin  The best medication to be given for gestational diabetes mellitus.
Bromocriptine o A dopamine agonist that is used in the treatment of
hyperprolactenemia.
o Side effect : postural hypotension
Norgestrel/Ethinyl estradiol (Ovral) o The most effective and the most common method of postcoital
contraception.
o Emergency contraception does not interfere with an established,
post implantation pregnancy.
Injectable medroxyprogesterone o Contraceptive method.
acetate (Depo-Provera) o It is not causally linked with thromboembolic events. So, it is
suitable for patients with sickle cell disease.
SSRIs o Considered first-line treatment for premenstrual dysphoric disorder
and postpartum depression.
Metronidazole  The most appropriate antibiotic used to treat Trichomonas vaginalis
and bacterial vaginosis.
RhoGAM (anti-D immunoglobulin)  The most appropriate pharmacotherapy for Rh negative pregnant
mom.
Angiotensin-converting-enzyme  Contraindicated during pregnancy.
inhibitor
Abortion
Type Definition/ US findings
 Complete No products of conception found.
 Incomplete Some products of conception found.
 Inevitable Products of conception are intact but there is intrauterine bleeding and
dilation of cervix.
 Threatened Products of conception intact, +ve bleeding, no cervical dilation.
 Missed abortion Death of fetus, but all products of conception are present in the uterus.
 Septic abortion Infection of the uterus and the surrounding area.
Pregnancy and Heart Disease

 The most common cause of deterioration of cardiac status in a pregnant woman with rheumatic
heart disease is mitral stenosis.
 Severe mitral regurgitation and rheumatoid arthritis are tolerable during pregnancy.
 The most dangerous heart disease in pregnant women is: peripartum cardiomyopathy, then
Eisenmenger syndrome.
postpartum Maternity blues Postpartum depression POSTPARTUM PSYCHOSIS

psychiatric illness (Most severe form)
Onset Postpartum blues develop Postpartum depression Postpartum psychosis

on the third or fourth tends to start within a develops usually in the
postnatal day. Symptoms month of delivery. Many second postnatal week.
resolve within days. cases resolve within few
weeks.
Disease Hydatidiform mole

Association  Absence of fetal heart sound.
 Increase fundal height more than expected.
 Vaginal spotting.
 Vomiting.
 Proteinuria.
 Increase level of B-hCG.
Most useful Ultrasound
diagnostic procedure
Quick revision
 The most appropriate diagnosis for a woman presented with greyish fouly smelling acidic vaginal
discharge (PH<4) associated with Itching, and wet smear showed presence of clue cells is
bacterial vaginosis.
 The most likely diagnosis of a pregnant women presented women presented with sudden onset
of lower abdominal pain, fainting, and the presenting part cannot be felt on vaginal examination
is uterine rupture.
 In the symptomatic patient with uterine fibroids unresponsive to medical therapy, myomectomy
is recommended over fibroid embolization for patients who wish to become pregnant in the
future.
 Melasma or chloasma is common in pregnancy, with approximately 70% of pregnant women
affected. It is an acquired hypermelanosis of the face, with symmetric distribution usually on the
cheeks, nose, eyebrows, chin, and/or upper lip.
 Treatment of asymptomatic Chlamydia trachomatis infections in women reduces their risk of
developing pelvic inflammatory disease, tubal infertility, ectopic pregnancy, and chronic pelvic
pain.
 Thyroid function must be evaluated in women with postpartum depression.
 The criteria for severe preeclampsia specify a blood pressure of 160/110 mm Hg or above on two
occasions, 6 hours apart. Other criteria include Proteinuria above 5 g/24 hr, thrombocytopenia
with a platelet count<100,000/mm3, liver enzyme abnormalities, epigastric or right upper
quadrant pain, and alteration of mental status.
 The risk of breast cancer is increased by late pregnancy.
 Carcinoma of cervix is associated with HPV subtype 16, 18, 31, 45.
 Hyperemesis gravidarum is associated with increased liver enzymes in 25% of cases.
 Consumptive coagulopathy (DIC) is one of complications of IUFD after 4 weeks.
 Vaginal hysterectomy is contraindicated in menstruating women.
 Active pelvic inflammatory disease is an absolute contraindication for IUD.
 Glycosuria may develop in the normal pregnancy because there is an increase in glomerular
filtration rate of glucose without an increase tubular reabsorption.
 Papillary projection of ovarian cyst in ultrasound suggests the need for immediate laprotomy.
 The initial step in evaluation of a woman of childbearing age with a history of abdominal pain and
vaginal spotting is pregnancy test (urine or serum B-hCG).
 Persistent and recurrent vaginal candidiasis (Monilial Vaginitis) is associated with DM.
 Recurrent vaginal infection in prepubertal girls mainly due to mixed normal flora.
 Histopathology of papillary serous cystadenocarcinoma (Common form of malignant ovarian
cancer) shows psammoma bodies.
Management of preterm labor includes Management of severe preeclampsia

 Tocolytic(Magnesium sulphate)  Hydralazine
 Antibiotic(Penicillin: prevention of GBS)  Magnesium sulphate
 Corticosteroid(Dexamethasone: reduction  Delivery Labor induction with IV
of RDS,IVH and perinatal mortality) Oxytocin
 Note: Prior to 32 weeks
Expectant management and administration
of glucocorticoids
Amenorrhea: absence of menstrual periods, either on a permanent or temporary basis.
Type Primary amenorrhea Secondary amenorrhea
Definition Menstrual periods have never a-Previously regular cycles: 3
begun (by age 16) months of no Menses
b-Previously irregular cycles: 6
months of no Menses
Most common causes -The most common cause of -The most common physiologic
primary amenorrhea is Turner's cause of secondary amenorrhea
syndrome. is pregnancy.
-The most common anatomic
cause of secondary amenorrhea
is Asherman’s syndrome.
Oral contraceptives
Benefits On the other hand
-Reduction the risk for carcinoma of the ovary, - Oral contraceptives do not reduce the risk of
endometrium and colorectum. carcinoma of the breast, cervix, lung, or head and neck.
- Reduction the risk of postmenopausal fractures. -The risk of thromboembolism is increased.
Oral contraceptive pill (OCP) is contraindicated in
 Pregnancy May lead to VACTERL (a malformation complex of Vertebral, Anal, Cardiac, Tracheo-
Esophageal, Renal and Limb anomalies)
 Lactation This is because the use of oral contraceptives may diminish the quality and quantity of
milk in the post-partum period.
‫‪Notes‬‬
Surgery
The most common
Question Answer
1 Cause of necrotizing fasciitis Group A Streptococcus
2 Causative organism of furuncle Staphylococcus aureus
3 Cause of bloody nipple discharge Benign Intraductal papilloma
4 Histological type of breast cancer Infiltrating ductal
5 Site of metastasis of carcinoma of breast Spine
6 Site of metastasis of carcinoma of colon Liver
7 Hernia Indirect inguinal hernia
8 Side of Indirect inguinal hernia Right side
9 Hernia that prone to be incarcerated Femoral hernia
10 Causes of hemorrhagic cystitis Cyclophosphamide and Radiation
11 Cause of urinary incontinence in elderly Detrusor instability
12 Mode of presentation of Prostatic cancer nowadays Elevated PSA and/or Abnormal
findings on digital rectal examination
13 Initial sign of testicular cancer Painless testicular enlargement
14 Complication post Transurethral resection of the prostate Hypokalemia
15 Cause of fever first day post operative Atelectasis
16 Cause of hyponatremia in a post operative patient Excess water
17 Site of stone entery in "gallstone ileus" A cholecystoduodenal fistula
18 Cause of acute mesenteric ischemia Superior mesenteric artery embolism
19 Location of appendix Retrocecal
20 Type of gall bladder stone Mixed
21 Cause of death during vascular surgery Myocardial infarction
22 Parotid malignancy Mucoepidermoid carcinoma
23 Parotid benign tumor Mixed tumor
24 Cause of constipation Intestinal obstruction
25 Site of duodenal ulcer First part of duodenum
26 Location of anal fissure Posteriorly in the midline
Most common renal stone Second most common renal stone

Calcium oxalate Uric acid
Radio-opaque Radiolucent
Evaluation of thyroid nodule

First step Low TSH Normal or high TSH
Second step A radionuclide thyroid scan A fine-needle aspiration biopsy of the nodule
-Most important diagnostic test should be carried out for a patient presented with thyroid nodule is fine needle
aspiration.
Intestinal pseudo-obstruction (i.e. no mechanical lesion but clinical and radiological features of
obstruction) may be a manifestation of:
well recognized causes: rarely, it is the presenting manifestation of occult
neoplasm:
 Amyloidosis  Small cell lung carcinoma
 Lead poisoning  Pheochromocytoma
 Parkinson’s disease
 Progressive systemic sclerosis
 Diabetes mellitus
 Hypothyroidism
 Chronic phenothiazine therapy
-Conditions lead to chronic overflow incontinence -Conditions lead to automatic bladder emptying
caused by obstruction at the bladder neck or a
hypotonic bladder caused by autonomic neuropathy can
result in hydronephrosis and impaired renal function
1- Benign prostatic hypertrophy 1- Multiple strokes
2- DM 2- Alzheimer's disease
3- Hypothyroidism 3- Brain tumors
4- Uremia 4- Normal-pressure hydrocephalus
5- Collagen vascular disease
6- Guillain-Barre syndrome
Term Meaning
Modified radical mastectomy Removing of breast, axillary nodes (1, 2) and nipple
areolar complex. Pectoralis major and minor are
not removed. Drains are placed to drain lymph
fluid.
Proctalgia fugax (Levator Syndrome) An episodic, sudden, sharp pain in the anorectal area
lasting several seconds to minutes.
Boil (furuncle) An acute deep infection of hair follicle (folliculitis).
Voiding symptoms
Irritative Obstructive
-Urgency -Hesitancy
-Dysuria -Decreased force of stream
-Frequency -Intermittency
-Nocturia -Postvoiding dribbling
Question Answer
 The most accurate diagnostic tool for acute appendicitis CT scan
 The most appropriate diagnostic step for renal cell carcinoma CT scan
 The most sensitive and specific radiological test for diagnosis of diverticulitis CT scan
 The best initial radiological test for a patient presented with renal colic KUB
 The most appropriate initial test done in a patient with hematuria Intravenous pyelogram
 The most effective method of screening for colon cancer Colonoscopy
 The most sensitive and least expensive method to discriminate Ultrasound Doppler
between testicular and extratesticular masses
 The most useful tool to roll out bladder injuries in trauma patients Retrograde cystogram
 The most useful tool to detect early bladder cancer Cystoscopy
 The definitive in a prostate cancer Prostatic biopsy
 The definitive diagnostic method in Hirschsprung disease Rectal biopsy
 The most appropriate step in diagnosis of post operative pulmonary Spiral CT scan
thromboembolism
 The definitive diagnostic method of post operative pulmonary Pulmonary
thromboembolism angiography
Laboratory marker Indication

AFA Hepatocellular carcinoma
CEA Metastatic colon cancer
5 HIAA Carcinoid tumor
Classification of thyroid cancer Comment

Papillary The commonest type and has excellent prognosis, metastasize
mainly through lymphatics route.
Follicular The second most common, metastasize mainly through
hematogenous route.
Medullary The third most common and the most likely having familial
tendency, originates from the parafollicular cells (C cells).
Anaplastic The worst prognosis.
Disease Radiological findings The most appropriate The definitive
initial step in treatment
management
Hirschsprung disease Multiple dilated small Diverting ileostomy (to Total colectomy
loops of small bowel relieve the functional
and microcolon. obstruction) and
appendectomy (to obtain
tissue for pathology).
Types of germ cell tumor

 Teratoma/Dermoid cyst ( most common)
 Sertoli-Ledyding cell tumor
 Granulosa theca cell tumor
sign Indication
 Cullen's sign Bruising around umbilicus and it indicates hemorrhagic
pancreatitis or ruptured abdominal aortic aneurysm.
 Grey turner's sign Bruising in the flank and it indicates retroperitoneal hemorrhage.
 Kher's sign Pain in the left shoulder and it indicates splenic rupture.
 Balance sign Dull percussion of the left and shifting dullness on the right and it
indicates splenic rupture.
 Seatbelt sign Bruising where seatbelt was, and it indicates deceleration injury.
Factors cause elevated results on prostate-specific Factor does not elevate results on prostate-specific
antigen (PSA) screening antigen (PSA) screening
 Performance of prostate massage  Performance of a rectal examination
 Performance of cystoscopy
 Urinary tract infection
 Urinary retention
Burn
 Rule of 9's for Adults: 9% for each arm, 18% for each leg, 9% for head, 18% for chest, 18% for
back and 1% for perineum.
 Rule of 9's for Children: 9% for each arm, 14% for each leg, 18% for head, 18% for chest, 18% for
back and 1% for perineum.
 Fluid Requirements = Total body surface area burned(%) x Wt (kg) x 4mL
Give 1/2 of total requirements in 1st 8 hours, and then give 2nd half over next 16 hours.
 The initial management of an adult patient presented with major burn is IV crystalloid.
Indirect inguinal hernia Direct inguinal hernia
-More frequent (85%). -Less frequent (15%).
-Patient is usually young, and it is about 20 times -Patient is usually old, and it is about 8 times more
more common in male than female, and nearly one common in male than female, and most cases are
third are bilateral. bilateral.
-Hernia may reach the scrotum or labium majus, -Hernia comes forward through the posterior wall
because it passes through the deep inguinal ring, of the inguinal canal medial to the inferior
traverses the inguinal canal and comes out through epigastric vessels.
the superficial inguinal ring. -The hernia sac is globular and lies behind the
-The hernia sac is elongated and lies in front of the spermatic cord.
spermatic cord. -The neck of the sac is wide.
-The neck of the sac is narrow.
-The hernia sac is the remain of the processes
vaginalis Congenital origin.
Inguinal hernia Femoral hernia

 Hernia bulges above the inguinal ligament.  Hernia bulges below the inguinal ligament.
 Hernia sac is above the pubic tubercle.  Hernia sac is below and lateral the pubic
tubercle.
 Hernia is more common in males  Hernia is more common in females.
 (Well developed inguinal canal)  (Wider femoral ring)
Condition Features
 Testicular torsion o Acute pain and swelling (Emergency case).
o Affected testis typically lies higher.
o Primarily affects teenagers.
o Abnormal cremastric reflex.
 Epididymo-orchitis o Acute pain, nausea and fever.
o Pain relief upon elevation of scrotum.
 Hydrocele o Transilluminates.
o Sometimes associated with testicular tumors.
o Insidious, painless.
 Varicocele o Contorted, dilated veins.
o Feels like a “bag of worms”.
o May cause infertility.
o Empties with patient in supine position.
o Insidious, painless.
 Testicular cancer o Usually painless mass.
o Sometimes may resemble epididymitis.
o Spread very easily especially during vigorous
palpation or biopsy.
Over (abnormal) healing
 Hypertrophic scar  Keloid scar
o Hypertrophic scars develop soon after o Keloid scars may not develop for several
injury; they are confined to the wound months, but rarely subside and often
and usually subside over time. progress.
o They favor flexor surfaces and are o Keloids overgrow the boundaries of the
common over the shoulder joint. injury and are prone to develop on the
ear lobes and the pre-sternal skin.
o In contrast to hypertrophic scars, the
magnitude of a Keloid scar is not
proportional to the magnitude of the
injury.
o Keloids recur after surgical excision, but
this may be prevented by preoperative
radiotherapy or intradermal steroid
injections.
Fibrocystic change Breast cancer

 Often bilateral  Often unilateral
 Multiple nodules  Single mass
 Menstrual variation  No cyclic variations
 May regress during pregnancy
 Fibrocystic change does not increase risk of
breast cancer, but makes detection more
difficult
Cancer statistics in both genders

 Incidence
Male Female
1. Prostate 1. Breast
2. Lung 2. Lung
3. Colorectal 3. Colorectal
 Mortality
Male Female
1. Lung 1. Lung
2. Prostate 2. Breast
3. Colorectal 3. Colorectal
Radiology and surgery
 Pulmonary contusion produces classic "white-out" of lungs on CXR, where the contused lung is
exquisitely sensitive to fluid overload and the fluid leaks easily along with signs of respiratory distress.
 Pneumatosis intestinalis is a radiological sign which is highly suggestive for necrotizing enterocolitis.
 Corkscrew appearance is associated with malrotation with midgut volvolus/ and esophageal spam.
 The double bubble sign with a little gas beyond is highly suggestive of malrotation.
Case Diagnosis
 Congenital cystic dilatations of the biliary tree associated with jaundice, fever, Choledochal cysts
and intermittent abdominal pain, an abdominal mass and direct
hyperbilirubinemia
 The most probable diagnosis of a patient presented with pallor, paraesthesia, Arterial thrombosis
and pulsnessless of lower limb
 The most probable diagnosis of a female presented with firm, movable, rubbery Fibroadenoma
breast mass
 The most likely cause of recurrent painful swelling of the submandibular Calculi
gland
Quick revision
 Villous adenomas are the most likely to develop into adenocarcinoma.
 Familial adenomatous polyposis (Autosomal dominant type) carries 100% risk for colorectal cancer.
 The treatment of choice of thrombosed external piles is local anesthesia and thrombectomy.
 Seminoma is a radiosensitive and highly curable tumor. The main risk factor is cryptochidism.
 Bloody fluid obtained by fine-needle aspiration of a breast nodule (simple cyst) must be sent
for cytological examination.
 Peritonitis is an indication of diagnostic peritoneal lavage in trauma victim.
 Borders of Hesselbach triangle are inferior epigastric vessels, rectus sheath and inguinal ligament.
 The inguinal ligament is formed by the lower most border of external oblique aponeurosis.
 The most important early sign of wound infection is pain at the wound.
 The best indicator for adequate IV fluid is adequate urinary output.
 In acute appendicitis, rigidity may be absent if the appendix is pelvic in position.
 A cold abscess is an abscess that usually accompanies tuberculosis commonly in the lymph nodes and
bone.
 Excision rather than bypass is preferred for surgical treatment of small intestine Crohn's disease,
because it reduces small intestine cancer.
Pharmacology
 Starting an Alpha-blocker (tamsulosin (Flomax)) at the time of insertion of the urethral catheter has
been shown to increase the success of a voiding trial.
 Initiation of statins (lipid lowering drugs) prior to vascular surgery (e.g., iliofemoral bypass) have been
shown to have plaque-stabilizing and vascular anti-inflammatory effects and it significantly reduces
cardiovascular risk.
 Fiber supplementation for patients with symptomatic hemorrhoids is very helpful in decreasing
bleeding, pain, prolapse and itching.
‫‪Notes‬‬
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Orthopedic surgery
The most common
Question Answer
1 Cause of pathologic fracture Osteoporosis
2 Causative organism of acute infectious (septic) Staphylococcus aureus
arthritis overall in adults and children
3 Causative organism of acute infectious (septic) Neisseria gonorrhoeae
arthritis in young, sexually active adults
4 Route of acute infectious (septic) arthritis Hematogenous
5 Joint affected in acute infectious (septic) arthritis Knee
6 Nerve injury associated with fracture of humerus Radial nerve
7 Cause of joint disease Osteoarthritis
8 Cause of hand infection Trauma
9 Cause of avascular necrosis Trauma
10 Location of intervertebral disc herniation L5-S1
11 Cause of pathologic fracture Osteoporosis
12 Bacterial causative organism of osteomyelitis Staphylococcus aureus
overall
13 Bacterial causative organism of osteomyelitis in Salmonella
sickle cell disease patients
14 Bacterial causative organism of osteomyelitis in Polymicrobial infection
diabetic patients who develop a “diabetic foot”
15 Finding of osteomyelitis Pain over the involved area of bone
16 Dislocated joint in children Elbow
Bone tumors
 The most common type of bone tumor Metastatic
 The most common primary bone cancer Osteosarcoma
 The second most common primary bone cancer Ewing's sarcoma

Question Answer
The most effective imaging study for diagnosing osteomyelitis MRI
and assessing the extent of disease process
The most direct and accurate diagnostic method of Needle aspiration of infected
osteomyelitis bone or bone biopsy
The most appropriate next step in management of a patient Diagnostic arthrocentesis
presented with a history suggestive of septic arthritis (synovial fluid analysis)
The most sensitive and specific way of investigating patients MRI
with Avascular necrosis
The best diagnostic test for osteoporosis A central DXA scan of the hip,
femoral neck, and lumbar
spine
Laboratory markers
Question Answer
Major circulating form of vitamin D Serum 25-hydroxyvitamin D
The most important regulator of serum Parathyroid hormone
1,25(OH)2 Vitamin D
The initial parameter to assess response to Raised serum Phosphorus then raised serum
Vitamin D supplements Calcium
Pyogenic tenosynovitis
Symptoms and signs Progressively worsening pain in the index finger.
On examination the finger is swollen and held in a flexed position. The
pain increases with passive extension of the finger, and there is
tenderness to palpation from the tip of the finger into the palm.
Early treatment -Antibiotics and splinting
(Within 48 hours of
onset)
Late treatment - Surgical drainage and antibiotics
(After 48 hours)
History A patient presented with maximum tenderness in the area of

the anatomic snuff box after falling on his outstretched hand.
Most probable diagnosis Scaphoid fracture.
Most appropriate management A thumb spica splint and follow-up radiographs in 2 weeks.
Plantar fasciitis
Symptoms Typically the pain is located in the plantar surface of the heel and is worst when
the patient first stands up when getting out of bed in the morning (first step
phenomenon) or after prolonged sitting. The pain may then improve after the
patient walks around, only to worsen after prolonged walking.
Signs Typical findings include point tenderness to palpation on the plantar surface of
the heel at the medial calcaneal tuberosity where the calcaneal aponeurosis
inserts.
First line treatment Over-the-counter heel inserts
Alternatives to the bisphosphonates(Alendronate)

Medications Advantages
Intravenous zoledronic acid Reduce both hip fracture risk and
vertebral fracture risk
Teriparatide, raloxifene and Calcitonin-salmon Reduces vertebral fracture risk but not hip
fracture risk
Quick review
Question Answer
Typical radiographic findings of osteoarthritis -Joint space narrowing
include -Osteophytes
-Subchondral bone sclerosis and pseudocysts
Typical examination findings of osteoarthritis -Joint crepitus
are -Joint swelling
-Limited range of motion
The most frequent ligament injury among Medial collateral ligament sprain
traumatic knee injuries
Mechanism of medial collateral ligament sprain It results from to lateral blow to the joint
Presentation of medial collateral ligament The patient may present with tenderness along
sprain the median aspect of the joint line and
increased laxity in a valgus stress with flexed
knee at 30 degrees.
Maneuver for detecting meniscal tears McMurray’s test is used to detect meniscal
tears
Maneuvers for detecting an anterior cruciate The most accurate maneuver for detecting an
ligament (ACL) tear ACL tear is the Lachman test, followed by the
anterior drawer test and the pivot shift test.
The strongest risk factor for osteoporosis Age
Saturday night palsy definition An acute radial mononeuropathy which results
from compression of the radial nerve at the
spiral groove
Benefit of vitamin D in elderly Vitamin D decreases the risk of fall in elderly
Management of femur fracture  Intratrochantric fracture
(extracapsular): closed reduction and
internal fixation
 Intracapsular: prosthetic femoral head
replacement
Pathognomonic diagnostic sign for carpal Tinel’s sign
tunnel syndrome
Types of Epicondylitis  Lateral Epicondylitis (Tennis elbow)
 Medial Epicondylitis (Golfer’s elbow)
Types of limp Pathology

Antalgic Hip joint arthritis
Trendelenburg Weakness of hip abductors
High stepping gait Foot drop secondary to common peroneal nerve palsy
Spastic Cerebral palsy
Ataxic Cerebellar pathology
Pediatric Orthopedics
 The most probable diagnosis of 6-years old boy presented with a history of insidious
development of limping with decreased motion in one hip, occasional ipsilateral knee
pain and antalgic gait is avascular necrosis of the capital femoral epiphysis (Legg-Calve-
Perthes disease).
 The most probable diagnosis of a choppy 12-14 years old boy presented with hip pain
and inability to internally rotate the hip is Slipped capital femoral epiphysis. The
radiological sign is "melting ice cream cone".
 The most common cause of knee pain in pediatric age group is Osgood–Schlatter disease.
Elbow fracture in pediatric age group

-The most common type Supracondylar fracture
-The most serious complication Volkmann Ischemic contracture (Compartment syndrome)
-Management Manipulation, reduction, and immobilization of the arm at
90 degrees with slight pronation.
Nerve Motor deficit Sensory deficit Common cause Clinical findings

Radial Wrist extension Dorsal forearm Humeral fracture Wrist drop
and hand
(The first 3 fingers)
Median -Pronation Palmar surface Carpal tunnel Weak wrist flexion
-Thumb opposition (The first 3 fingers) syndrome and flat thenar
eminence
Ulnar Finger abduction Palmar and dorsal Elbow dislocation Claw hand
surface
(The last 2 fingers)
Axillary Abduction Lateral shoulder Anterior humeral -Numbness over
dislocation the deltoid muscle
on the outer upper
arm.
-Difficulty raising
the arm out to the
side.
-Wasting of the
deltoid muscle in
prolonged injuries.
Peroneal -Dorsiflexion Dorsal foot and Knee dislocation Foot drop
-Eversion lateral leg
‫‪Notes‬‬
Otorhinoloryngology
The most common
Question Answer
1 Site of malignancy in paranasal sinus Maxillary sinus
2 Cause of otorrhea Acute otitis media
3 Cause of chronic cough Post nasal drip
4 Cause of acute sinusitis Viral
5 Sinuses involved in sinusitis Maxillary sinuses
Ménière’s disease
Ménière’s disease (also called endolymphatic hydrops) is a long term, progressive condition affecting the
balance and hearing parts of the inner ear.
Presentation: Triad of (Tinnitus, Vertigo and Sensorineural Hearing Loss) associated with (Headache, Ear
pressure and Nystagmus)
Quick revision
Question Answer
 The most likely diagnosis of a child presented with Retropharyngeal abscess
dysphagia and increasing sore throat and soft tissue
swelling of the posterior pharyngeal wall post upper
respiratory tract infection
 The most probable diagnosis of a child presented with Peritonsillar abscess
difficulty of swallowing and deviated uvula
 The most probable diagnosis of a child presented with Foreign body
foul-smelling unilateral nasal discharge
 A condition of rebound nasal congestion brought on by Rhinitis medicamentosa
extended use of topical decongestants (e.g.,
Oxymetazoline, Phenylephrine, Xylometazoline, and
naphazoline nasal sprays) that work by constricting blood
vessels in the lining of the nose
 The most sensitive physical finding for otitis media Tympanic membrane immobility
Allergic rhinitis
Pharmacologic measures  Intranasal corticosteroids are the most effective treatment
for mild to moderate allergic rhinitis and should be first-line
therapy.
 Second-line therapies that can be used for symptoms that do
not respond to initial treatment include antihistamines,
decongestants, cromolyn, and leukotriene receptor
antagonists.
Nonpharmacologic measures  Nasal irrigation and avoiding irritants.
 The most and best desirable treatment for nasal allergy is
allergen avoidance.
‫‪Notes‬‬
Ophthalmology
The most common
Question Answer
1 Cause of uncorrectable visual loss in children Amblyopia
2 Cause of Amblyopia Strabismus
3 Cause of visual loss in elderly Macular degeneration
4 Cause of preventable blindness worldwide Chlamydia trachomatis infection
5 Cause of red eye Conjunctivitis
6 Cause of conjunctivitis Viral
7 Virus associated with conjunctivitis Adenovirus
8 Bacteria associated with conjunctivitis Streptococcus pneumoniae
9 Type of Glaucoma Open angle Glaucoma
10 Cause of spontaneous vitreous hemorrhage Proliferative diabetic retinopathy
11 Cause of Pupillary dilatation Compression of oculomotor nerve
Findings Associated diseases/causes

Bitemporal hemianopia Usually caused by a pituitary tumor
Retrobulbar neuritis Initial sign of multiple sclerosis
Intraocular opthalmoplegia Classically found in multiple sclerosis
Optic neuritis -Viral infection
-Multiple sclerosis
-Vasculitis
-Methanol
-Meningitis
-Syphilis
-Tumor metastasis
Kayser-Fleischer ring Pathognomonic for Wilson’s disease
Argyll Robertson Pupil Pathognomonic for tertiary syphilis (neurosyphilis)
Lens dislocation Upward: Marfan’s syndrome
Inferiorly: Homocystinuria
Variably: Alport’s syndrome
Leukocoria (absent red reflex) Retinoblastoma
Roth spots Endocarditis
Copper wiring, flame hemorrhages, A-V nicking Subacute hypertension
-Atherosclerosis
Papilledema Increased intracranial pressure
Cherry-red spot on macula -Tay-Sachs disease
-Niemann-pick disease
-Central retinal artery occlusion
Retinal conditions presentation
Senile macular degeneration  Slow painless loss of central visual acuity
Retinal detachment  Painless blurred vision
Optic neuritis  Painful sudden loss of vision
Central retinal artery  Painless sudden loss of vision
Central retinal vein occlusion  Painless gradual loss of vision
-Glaucoma: Increased Intraocular Pressure with Optic Nerve injury

-Major cause of blindness in the aging and leading cause of blindness in African-Americans.
Type Information presentation Medical treatment surgical treatment
Open Angle - Loss of vision can -Asymptomatic -Prostaglandin Laser
Glaucoma be largely prevented until late stages. Analogues. trabeculoplasty
by regular eye -Gradual loss of -Intraocular Beta
check-ups peripheral vision Blockers (Timolol).
(measurement of (tunnel vision) is -Intraocular
ocular pressure ) the earliest Cholinergics
presenting (Pilocarpine).
symptom. -Intraocular
-The earliest Sympathomimetics.
finding (sign) of -Topical Carbonic
open angle Anhydrase Inhibitor
Glaucoma is (acetazolamide).
elevation in - Intraocular Alpha-
intraocular Adrenergic
pressure. (Apraclonidine).
Angle- - It is a medical -Rapid onset. -Systemic Carbonic Laser iridotomy

Closure emergency. -Severe pain. Anhydrase Inhibitor
Glaucoma -Due to blockage of -Blurred vision. (acetazolamide).
aqueous drainage. -Halos around -Intraocular Beta
-May be precipitated lights. Blockers (Timolol).
by pupil dilation -Redness. - Intraocular Alpha-
(Mydriatics; -Fixed mid-dilated Adrenergic
atropine) pupil. (Apraclonidine).
-Intraocular
Cholinergics
(Pilocarpine).
-The commonest cause of intranuclear opthalmoplegia (INO) in young patient is multiple sclerosis.
-INO: abnormal horizontal ocular movements with lost or delayed adduction and horizontal Nystagmus of
the abducting eye.
-Optic neuritis is the initial symptoms in approximately 40% of persons who eventually are diagnosed with
multiple sclerosis.
-Optic neuritis is associated with partial or total loss of vision, pain on motion of the involved eye,
scotoma affecting macular vision, and a variety of other visual-field defects.
The tonometer's usage contraindications are the following:

-upper lid pathology (inflammatory diseases, scars, eyelid deformation);
-Expressed sclera and/or conjunctiva pathology in the measuring area.
Diabetic retinopathy Hypertensive retinopathy

-Non-proliferative: Keith Wagener Barker (KWB) Grades
-Microaneurysms
-Dot and blot hemorrhages Grade 1 Copper wire arterioles
-Flame-shaped hemorrhages
-Hard exudates Grade 2 As grade 1 + Vein indentations
-Cotton-wool spots (soft exudates) at a-v crossing or nicking or
-Venous loops and venous beading nipping
-Intraretinal microvascular abnormalities
-Macular edema Grade 3 As grade 2 + with cotton wool
-Proliferative: spots and flame-hemorrhages
-Neovascularization
Grade 4 As above but with swelling of
-Preretinal hemorrhages
the optic disk (Papilledema)
-Hemorrhage into the vitreous
-Fibrovascular tissue proliferation
-Traction retinal detachments
-Macular edema
In autoimmune thyroid eye disease

 The characteristic finding in thyroid eye disease is inflammatory swelling of the extraocular
muscles.
 Impairment of upward gaze in the abducted eye, because inferior rectus is most commonly
affected.
 The disease is both more severe and more common in males and cigarette smokers.
 Radioactive iodine has been associated with deterioration of the condition.
 Steroids are generally reserved for rapidly progressive disease where there is reduction in visual
acuity due to optic nerve compression at the apex of the orbit.
‫‪Notes‬‬
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Family medicine
The most common
Question Answer
1 known form of nutritional deficiency Iron deficiency
2 Cause of sore throat Viral
3 Causes of nausea and vomiting  Viral gastroenteritis
 Food poisoning
Type of prevention Examples

-Primary prevention attempts to prevent disease -Avoidance of cigarette smoking.
before it develops. -Immunization.
-Secondary prevention is based on early detection -Annual mammography for women older than 45
of an existing pathologic state before it causes years.
damage to the organism. -Control hypertension and blood lipid levels.
-Pap smear screening.
-Tertiary prevention is based on rehabilitative -Prophylactic aspirin after myocardial infarction.
interventions or other methods to improve the
clinical evolution of a disease that has already
developed.
Disease
Test or exposure (+) (-)
(+) A B
(-) C D
Sensitivity Specificity
Percentage of patients with a disease who have a Percentage of patients without the disease who
positive test. have a negative test.
A / (A+C) D / (B+D)
Recommendations
Recommendation for the use of
aspirin in the primary prevention Sex Men Women
of cardiovascular disease Age 45–79 years of age 55–79 years of age
Potential benefits reduction in reduction in
myocardial ischemic strokes
infarctions
Blood pressure recommendations  The American Heart Association recommends a goal blood
in patients with diabetes mellitus, pressure of 130/80 mm Hg or less for the treatment of
chronic kidney disease, or coronary hypertension in patients with diabetes mellitus, chronic
artery disease. kidney disease, or coronary artery disease.
There are two recommended  Influenza vaccine- gives yearly to people at increased risk
methods for prevention of for complications and to health care workers.
pneumonia  Pneumococcal vaccine- for patients >65 years and for
younger people at high risk (e.g., those with heart disease,
sickle cell disease, pulmonary disease, diabetes, or alcoholic
cirrhosis, or asplenic individuals)
Colon cancer screening

Family history No family history Positive family history (one first
degree relative diagnosed with
colorectal cancer or
adenomatous polyps before age
60, or at least two second
degree relatives with colorectal
cancer, are in the highest risk
group)
Age for cancer screening -From age ≥ 50 years -At age 40, or 10 years before the
earliest age at which an affected
relative was diagnosed
(whichever comes first) and be
rescreened every 5 years.
Screening method -Annually: Fecal occult blood test Colonoscopy is the preferred
or screening method
-Every 5 years: Flexible for this highest-risk group
sigmoidoscopy or double
contrast barium enemas
or
-Every 10 years: Colonoscopy
Vitamins and Nutritional deficiencies
B1 (Thiamine) -Dry Beriberi (Neuropathy)
-Wet Beriberi (High-output cardiac failure)
-Wernicke-Korsakoff’s syndrome
B2 (Riboflavin) Cheilosis (Mouth fissures)
B3 (Niacin) Pellagra (Diarrhea, Dementia, Dermatitis)
B6(Pyridoxine) -Dermatitis
-Stomatitis
-Glossitis
-Peripheral neuropathy
B12(Cyanocobalamin) -Megaloblastic anemia
-Posterior spinal column neuropathy
-Peripheral Neuropathy
-Atrophic Glossitis
Folic acid -Neural tube defect
-Megaloblastic anemia
Vitamin A -Night blindness
-Corneal ulceration
-Acne
-Bitot’s spots
-Frequent respiratory infections
Vitamin D -Rickets
-Osteomalacia
Vitamin E -Opthalmoplegia
-Sensory and motor peripheral neuropathy
-Fragile RBCs
Vitamin K Clotting deficiency
Vitamin C Scurvy (poor wound healing, bleeding gum, purpura, easy bruising)
Iron -Anemia
- koilonychias (spoon-shaped nails)
-Brittle hair
-Loss of appetite
-pruritis
-Glossitis
-Cheilosis
Iodine -Hypothyroidism
-Cretinism
-Goiter
Quick revision
Question Answer
 Anticholinergic drugs (e.g., Benzotropine) are  Angle-Closure Glaucoma
contraindicated in  Urinary retention
 GI obstruction
 Female Athlete triad  Amenorrhea
 Disorder eating
 Osteoporosis
 Treatment options of nonspecific chronic back pain  Analgesics (acetaminophen,
tramadol, NSAIDs)
 Multidisciplinary
rehabilitation
 Acupuncture
 The organisms causing Non-Gonococcal Urethritis  Chlamydia trachomatis 40%
 Ureaplasma urealyticum
 Trichomonas vaginalis
 Candidiasis
 Herpes Simplex
 pharmacological prevention of acute mountain
sickness Acetazolamide Contraindicated
in patients with
a sulfa allergy
Dexamethasone An effective
prophylactic
and treatment
agent
 Incidence definition Number of new disease cases per

population at risk measured over a given
time interval.
 Prevalence definition Number of current cases per population
at risk measured over a given time
interval.
 P value  The measured probability of a
finding occurring by chance
alone, given the null hypothesis
is actually true.
 Significant P value is < 0.05
Laboratory markers, diagnostic and screening methods
Question Answer
 The gold standard non-invasive test for Serum Ferritin
diagnosing Iron deficiency anemia and the
best parameter to assess response to Iron
therapy
 The most effective method of screening for Colonoscopy
colon cancer
 The most effective method to reduce Screening mammography
breast cancer mortality for women
between 40-49 years of age
Stages in the Family-Life Cycle

 "Launching family" in family life cycle Starts when the first child- not necessarily the eldest -
leaves the home and ends when the last child leaves the home.
 In "The new couple "stage in family life cycle, the Couple must build a base of shared value such
as who will go to the grocery shopping or preparing the food.
 The highest incidence of divorce comes at Child rearing stage.
Drug Side effects

Hydroxychloroquine Retinal toxicity
Chloramphenicol Aplastic anemia
Nitrofurantoin Peripheral neuropathy
Gentamicin  Ototoxicity
 Nephrotoxicity
Tetracycline Dental staining of fetus if administered to the mother
Clindamycin Pseudomembranous colitis
Rifampicin  Red discoloration of urine
 Leukopenia
 Thrombocytopenia
‫‪Notes‬‬
Emergency medicine
Toxicology
Poison or Medication Antidote
Acetaminophen Acetylcysteine
Cholinesterase inhibitors Atropine, Pralidoxime
Quinidine or Tricyclic anti-depressants Sodium bicarbonate
Iron Deferoxamine
Digoxin Digoxin immune Fab
Methanol/ethylene glycol Ethanol
Benzodiazepines Flumazenil
Beta blockers Glucagon
Lead EDTA/Succimer
Cooper or gold Penicillamine
Opioids Naloxone
Carbone monoxide Oxygen
Muscarinic blockers Physostigmine
‫‪Notes‬‬
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Psychiatry
Quick review
Question Answer
Anorexia nervosa( 15% below normal weight ) is Amenorrhea, Osteoporosis, Hypokalemia,
associated with Raised plasma cortisol with loss of diurnal
variation, Hypoglycemia, Erosion of tooth
enamel, Bradycardia, Hypotension, Cardiac
arrhythmias, Edema, Hypothermia, Low
gonadotrophins and Low triiodothyronine
Antidepressants complications  Overconsumption of tyramine-containing
(Food and drugs interactions) foods (Cheese) in a patient receiving
MAOIs (Phenelzine) may result in
hypertensive crisis.
 Opiods (Meperidine and
dextromethorphan) may cause serotonin
syndrome in patients who are chronically
taking SSRIs or MAOIs.
Side effects of typical antipsychotic medications Extrapyramidal symptoms, Hyperprolactenemia,
anticholinergic effects, seizures and neuroleptic
malignant syndrome.
Side effects of atypical antipsychotic medications Weight gain, DM type 2, QTc prolongation and
agranulocytosis (clozapine)
The best initial treatment for major depressive Selective serotonin reuptake inhibitor
disorder, anxiety and social phobia
Electroconvulsive therapy (ECT) contraindications There are no absolute contraindications to
electroconvulsive therapy (ECT).
The most appropriate first line management of Atypical antipsychotics e.g. risperidone
severe behavioral symptoms with psychotic
features in nursing home patients
The only agents that have been approved by the Sertaline and Paroxetine
FDA for the treatment of Post traumatic stress
disorder
The best for rapid relief of symptoms in severely Alprazolam (xanax)
distressed patient with panic disorder
First-line treatment of Attention deficit hyperactivity Stimulant medication (e.g. Methylphenidate).
disorder
The Mini-Mental State Examination (MMSE) goal (MMSE) tests for cognitive function
Tourette’s syndrome association Tourette’s syndrome is often associated with psychiatric
comorbidities, mainly attention-deficit/hyperactivity
disorder and obsessive-compulsive disorder.
The most effective treatment of bulimia nervosa Fluxetine
A successful approach for treatment of the adolescent Family-based treatment for the adolescent with
with anorexia nervosa anorexia nervosa has been found to provide successful
results.
Somatoform and Factitious disorders
Unintentionally Intentionally
Concept A patient with -Factitious disorders: Malingering:

somatoform disorder Patients intentionally Patients intentionally
experiences psychiatric create an illness or create their illness for
stress and expresses it symptoms (e.g., they secondary gain (e.g.,
through physical inject insulin to create money, release from
symptoms. Patients do hypoglycemia) and work or jail)
not do so on purpose. subject themselves to
Major somatoform disorders procedures in order to
Somatization disorder The patient has multiple assume the role of a
(Briquet's syndrome) different complaints in patient (no financial or
multiple different organ other secondary gain).
system over many years -Münchausen syndrome
and has had extensive by proxy:
work-ups in the past. A behavior pattern in
Conversion disorder The patient has an which a caregiver
(Hysterical neurosis) obvious precipitating fabricates, exaggerates,
factor (e.g., fight with or induces health
boyfriend), then problems in those who
develops unexplainable are in their care.
neurologic symptoms
(e.g., blindness, stocking-
glove numbness).
Hypochondriasis The patient continues to
believe that he or she
has a serious disease
despite extensive
negative work-up.
Body dysmorphic The patient is
disorder preoccupied with an
imagined physical defect;
for example, a teenager
who thinks that his or her
nose is too big when it is
normal size.
Treatment Treat all somatoform
disorders with frequent
return visits to the clinic
and/or psychotherapy.
Screen for and treat any
coexisting depression.
Antipsychotics side effects Description
Acute dystonia  Occurs within hours of medication (most common with high-
potency IM use).
 Torticollis, jaw dislocation and tongue protrusion.
 Usually disappears eventually (Tolerance).
Akathisia  May occur at any time.
 Feeling of muscular discomfort.
 Relentless movements.
Parkinsonism  Occurs within weeks to months.
 Muscle stiffness: Cogwheel rigidity.
 Shuffling, drooling.
 Usually disappears eventually (Tolerance).
Tardive Dyskinesia  Occurs after many months of treatment.
 Choreoathetosis, tongue protrusion and lateral movements of jaw.
 Most mild cases eventually remit but more severe ones are often
irreversible.
Malignant syndrome  High fever, heart rate and blood pressure.
 Muscle rigidity.
Antidepressants Side effects

 Serotonin selective reuptake inhibitors -Decreased libido
-Insomnia
-Restlessness
-Decreased appetite
 Tricyclic antidepressants -Blurred vision
-Dry mouth
-Constipation
-Urinary retention
-Sedation
-ECG changes; depressed ST and prolonged PQ
 Monoamine oxidase inhibitors -Orthostatic hypotension
-Weight gain
-Edema
 Lithium -Tremors
-Nausea, vomiting, diarrhea
-Confusion
-convulsions
-Ataxia
Tricyclic compounds overdose( anticholinergic effects)
Presentation Management
Mild -Midyriasis -Main goal: Maintenance of serum PH at 7.50 (alkalotic
-Impaired sweating state) by:
-Constipation 1-Hyperventolation
-Flushed skin 2-IV bicarbonate
-Tachycardia 3-Gastric aspiration and lavage should be performed to
-Muscle twitching eliminate unabsorbed drug if more than 750 mg of TCA
Moderate -Cardiac arrhythmias (ventricular has been taken.
tachyarrhythmia and bradycardia)
-prolongation of the QRS complex (>0.1)
Severe -Seizure
-Severe hypotension
-Coma
Dysthymic disorder Cyclothymia

Characterized by depressed mood for at least 2 Chronic, but less extreme, form of bipolar disorder
years in addition to at least two of the following: that consists of short periods of mild depression
change in appetite, alteration in sleep, low energy, alternating with short periods of hypomania. The
low self-esteem, poor concentration, or feelings of onset of each phase is separated by short periods
hopelessness. There must be no history of a manic of normal mood. This diagnosis is excluded if the
or hypomanic episode, substance abuse, a chronic patient has had either a manic episode or a major
psychotic disorder, or an organic cause. depressive episode.
‫‪Notes‬‬
Dermatology and Immunology
The most common
Question Answer
1 Cause of Erythema multiforme Herpes simplex virus
2 Skin cancer Basal cell carcinoma
3 Cause of death due to skin cancer Melanoma
(Most aggressive form of skin cancer)
4 Type of alopecia Androgenetic baldness
5 Type of psoriasis Stable plaque psoriasis
6 Causative organism of cellulitis and erysipelas Group A streptococcus
7 Causative organism of folliculitis is Staphylococcus aureus
Erythrasma
Definition Causative Distribution Diagnosis Treatment
organism
-A skin disease Gram-positive In intertriginous -Wood's Lamp: Topical or oral
that causes small bacterium areas; Fluorescence erythromycin
reddish-brown Corynebacterium -Interdigital web coral red.
macules that minutissimum spaces -Gram Stain:
may coalesce -Gluteal crease Gram Positive
into larger -Inguinal area rod with long
patches with -Axilla filaments.
sharp borders. -Inframammary
-It is prevalent
among diabetics
and the obese,
and in warm
climates; it is
worsened by
wearing
occlusive
clothing.
Multiple seborrhoeic warts Cowden disease (multiple hamartoma

syndrome)
 May occur in any area where there are  Autosomal dominant condition
pilosebaceous follicles, but are most  Characterized by: multiple
commonly found on the face and trichilemmomas, buccal papillomatosis,
trunk. lipomas and angiomas.
 They are non-infective.  Predisposition to carcinoma of the
 They are best removed by curettage or breast and thyroid.
cryotherapy.
 They have a recognized association
with internal malignancy (Leser-Trelat
sign).
Types of Hypersensitivity Reaction
Type I hypersensitivity (or IgE-mediated -Anaphylaxis
immediate hypersensitivity) -Asthma
Type II hypersensitivity IgG- (or IgM- ) and Cytotoxic cell -Good pasture’s disease
mediated - Pemphigus vulgaris
Type III hypersensitivity Antigen-Antibody complex -SLE
-Arthus reaction
-Serum sickness
Type IV hypersensitivity (or T-cell mediated -Allergic contact dermatitis
delayed hypersensitivity) -Tuberculosis
-Transplant rejection
Quick revision
Question Answer
 Actinic keratoses definition Scaly lesions that develop on sun-exposed skin,
and are believed to be carcinoma in situ. While
most actinic keratoses spontaneously regress,
others progress to Squamous cell cancers.
 Cutaneous leishmaniasis definition Caused by an intracellular parasite transmitted
by the bite of small sand flies. Lesions develop
gradually, and are often misdiagnosed as
folliculitis.
 The most likely metal to cause contact Nickel
dermatitis
 The most likely diagnosis of frequent Angioedema
episodes of swollen lips and difficulty
breathing
 The scabies mite is predominantly Personal contact
transmitted by
 Tenia versicolor can be diagnosed by Hyphe
demonstration of
 First-line treatment of lichen planus High-potency topical corticosteroids such as
Clobetasol.
‫‪Notes‬‬
Objective Structured Clinical Examination
Diagnosis
Atrial fibrillation
Diagnosis
Atrial flutter
Diagnosis
Supraventricular tachycardia
Diagnosis
Ventricular tachycardia
Diagnosis
Ventricular fibrillation
Diagnosis
First degree heart block
Diagnosis
Mobitz type 1
Diagnosis
Mobitz type 2
Diagnosis
Third-degree atrioventricular block
Diagnosis
Anterolateral ST elevation MI
Diagnosis
Inferior wall MI
Diagnosis
Hyperkalemia
Diagnosis
Erythema nodosum
Diagnosis
Erythema multiforme
Audiogram interpretation
Normal hearing level
Sensory neural hearing loss
Conductive hearing loss
Mixed hearing loss
CTG interpretation
Acceleration
CTG interpretation
Early decelerations
CTG interpretation
Late decelerations
CTG interpretation
Variable decelerations
Blood Bottles Guide
Name this instrument
Intravenous cannula
Endotracheal tube
Name these instruments
Mechanical heart valves
Nasogastric tube
Grommet Tube
Ayre spatula
Sims Speculum
Cussco Speculum
Hegar's dilator
Amniohook
Ventouse
Double J Stents
Sangstaken-Blakemore tube
Diagnosis Right Pneumothorax
Management Chest tube insertion
Describtion and most likely diagnosis
Right middle lobe infiltration suggestive of pneumonia
Describtion AP view of Right arm showing a transverse
Mid Shaft humeral fracture with angulation
Management 1-U shaped splint ( conservative)
2- Open reduction internal fixation if
conservative failed
Complication Radial nerve injury
wrist drop
Diagnosis DDH developmental dysplasia of the hip
Tests Barlow's Test: dislocation
Ortolani test: relocation
Treatment pavlik harness
Type of radiological study Finding
Ultrasound Gallbladder stone
Diagnosis
Diaphragmatic hernia
Diagnosis
Cardiac tamponade
Diagnosis
Toxic megacolon
Can be a complication of IBD or Pseudomembranous colitis
Diagnosis
Pleural effusion
Diagnosis Staghorn stone
Type Struvite ( infectious)
Risk Factors •Anatomical malformation of the
urinary tract
•UTI
Management Admission
I.V analgesics
I.V hydration
I.V antibiotics
NPO
Percutaneous nephrolithotomy
A child developed these lesions after being taken to a farm
Diagnosis Urticaria
Common Nuts, Eggs, strawberries
causes Drugs: e.g. (Aspirin, NSAIDS, ACEI)
Infections
Insect bite
Treatment Make sure the airway is clear (make sure
there is no airway swelling due to
angioedema)
Antihistamine
If severe with angioedema give adrenaline
immediately.
Diagnosis Varicose veins
Pathophysiology Venous valves incompetency
Treatment 1-conservative :
Compression stockings
2- surgical :
• Sclerotherapy
• Stripping and ligation
Describe the •Protruded tongue
abnormalities. •Deviation of the tongue to the left side
•Atrophy and fasciculation on the left side
What is your Diagnosis? Left lower motor neuron hypoglossal nerve palsy (12)
What are the possible Tumor
causes? Trauma to the base of the skull
Multiple Sclerosis
Infection
Diagnostic test MRI
Diagnosis Causes
Right lower motor neuron facial Infections : e.g. HSV , HZV , Lyme disease
nerve palsy (bell’s palsy) Tumors
Autoimmune diseases
Central venous catheter
Indications Administration of fluid & drugs
Monitoring
Hemodialysis
Complications •Pneumothorax
•Hematoma
•Infection
•Thrombus
•Arrhythmias
Chalazion
Inflammation of a blocked meibomian
gland
Stye
An infection of the sebaceous glands of
Zeis at the base of the eyelashes, or an
infection of the apocrine sweat glands of
Moll
Diagnosis Papilledema
Causes Tumor
Malignant hypertension
Intracranial hemorrhage
Pseudotumor cerebri
Complication Optic atrophy
Visual loss
Describtion Plain radiograph of the right hip
joint showing comminuted displaced
angulated proximal femur fracture
Complications Hemorrhage
Pulmonary embolism/ fat embolism
Hematoma
Management Open reduction internal fixation,
Intramedullary nail, physiotherapy
Describtion X-ray showing:
Proximal humerus fracture with
displacement (surgical neck fracture)
Associated nerve injury Axillary nerve
Complications Weakness of the deltoid muscle
Open fracture
Malunion
Describtion X-ray showing:
•Flattening of the femoral head
•Irregular sclerosis
•Narrow cartilage space
•Lucency of the underlying bone
Diagnosis Avascular necrosis of the femoral head
Most common cause in Bahrain Sickle cell disease
Treatment Hydration
Analgesics
Exchange transfusion
Core decompression of the head
Describtion Bilateral diabetic ulcers of the feet located on the plantar
surface of both feet on weight bearing area , punched out
appearance, with callus formation around it’s borders
Diagnosis Diabetic foot ulcer

Management Education
Tight glycemic control
Good hygiene
Debridement
Dressing
Antibiotics
This patient presented with abdominal pain and
hematuria
What is your diagnosis? Henoch–Schönlein purpura

What are the lab findings? INCREASE IN:
Urea
 Creatinine
CRP
ESR
IgA
Platelets
How to confirm your Biopsy is the most accurate test and it will show
diagnosis? leukocytoclastic vasculitis (small vessels)
Treatment Conservative
What is the indication of Steroids are indicated in severe abdominal pain or
steroid therapy? progressive renal insufficiency
What is the name of this appearance? Bamboo spine
What is the diagnosis? Ankylosing spondylitis
What is the characteristic antigen? HLA- B27 antigen
Treatment NSAIDS, Methotrexate, Infliximab
A pregnant model with transverse lie
How to manage her delivery? External cephalic version by 37 weeks ,

Success rate is 50%
Prepare for LSCS
Blood matching and grouping
CTG , Biophysical profile
complications -Prolapsed cord
-Uterine rupture
-Antepartum hemorrhage
Mention 4 differential diagnosis of Pitryasis alba
not itchy hypopigmented lesions Pitryasis versicolor
Vitilligo
Mycosis fungoides
Most likely diagnosis Pitryasis Alba
Treatment Education
Avoid sun exposure
Non-soap cleanser
Topical steroids
PUVA therapy
Gastrostomy tube
Indications Enteral feeding, stroke, decompression ,
esophageal stricture, recurrent aspiration
Complications skin irritation, infection
Describtion Plain CXR showing cardiomegaly,
alveolar edema, haziness of vascular
margins
Differential diagnosis Cardiogenic pulmonary edema
Congestive heart failure
Foley’s catheter
Indications Urinary retention
Comatose patient
Anaesthesia or sedation
Urinary obstruction
Complications UTI
Urethral injury
Diagnosis Nephrotic syndrome
Diagnostic criteria Proteinuria > 3.5 g/day
Generalized edema
Hyperlipidemia
Hypoalbuminemia
Hypercoagulation
Diagnosis Scarlet fever
Causative organism Streptococcus pyogenes (group A)
Complications Sepsis
Glomerulonephritis
Rheumatic fever
Erythema nodosum
Treatment Amoxicillin
Diagnosis
Gouty tophi (nodules)
Describtion AP view of Chest x-ray showing bilateral
pulmonary infiltrates in the upper lobes
with cavity formation
Most likely diagnosis pulmonary T.B

Treatment Isoniazid , Rifampicin , Ethambutol,
Pyrazinamide
Ileostomy
Indications Diseases of the large intestine which may require surgical
removal including :
Crohn's disease
Ulcerative colitis
Familial adenomatous polyposis
Total colonic Hirschsprung's disease
Diagnosis Air under diaphragm
Causes Perforated duodenal ulcer
Perforated peptic ulcer
Ruptured diverticulum
Penetrating trauma
After laprotomy or laparoscopy
Intra uterine contraceptive device
Types 1-copper
2-Hormonal
Absolute contraindications -Current pregnancy
-Undiagnosed abnormal vaginal bleeding
-Acute infection
Relative contraindications -Previous ectopic
-History of STD
Complication -Increased bleeding
-Expulsion
-Uterine perforation
-PID
Diagnosis Causes
Tympanic membrane perforation -Trauma
-Otitis media
Diagnosis 1-Tinea capitis (scalp)
2- Tinea pedis (Athlete’s foot)
3- Tinea corporis (body)
Causative organism Dermatophytes
Treatment Topical antifungal e.g. meconazole
Diagnosis Down Syndrome
Common GIT problems Duodenal atresia
Radiological sign Double bubble
Tracheostomy tube
Indications -Severe facial trauma causing obstruction
-Edema from trauma, burns, infection, or anaphylaxis
-Supraglottic or glottic pathologic condition (e.g., infection,
neoplasm, bilateral vocal cord paralysis)
-Congenital anomaly (e.g., laryngeal hypoplasia, vascular
web)
-Severe sleep apnea not amendable to continuous positive
airway pressure devices or other less invasive surgery
Diagnosis Mucopolysaccharidosis
Genetics -Absence or malfunctioning of lysosomal

enzymes needed to break down molecules called
glycosaminoglycans (mucopolysaccharides).
-Hunter syndrome is X-linked.
-Hurler syndrome is autosomal recessive.
Physical -A flat nasal bridge

features -Thick lips
-Enlarged mouth and tongue
-Short stature with disproportionately Short trunk
(dwarfism)
-Excessive body hair growth
-Short and often claw-like hands
Complications -Hepatosplenomegaly
-Progressive joint stiffness, and carpal tunnel
syndrome
-Recurring respiratory infections are common
-Obstructive airway disease and obstructive sleep
apnea
-Hernias
Diagnosis Pancoast tumor
Eye findings -Ptosis
-Miosis
-Anhydrosis
Complications -Horner’s syndrome(compression of sympathetic ganglion)
-SVC obstruction
-Compression of subclavian artery
-Painful shoulder
-Pulmonary complications: hemoptysis , dyspnea
-Invasion of the brachial plexus.
Findings PA view of a plain chest X-ray showing dextrocardia,
right sided gastric bubble, and the left hemidiaphragm is
elevated more than the right suggesting that the liver is
present on the left side.
Diagnosis Kartagener syndrome
( situs inversus totalis)
(Immotile cilia syndrome)
Complications -Infertility
-Infection ( bronchoectasois )(recurrent chest infections)
-Icteric
-Short stature
-Sinusitis
-Suppurative otitis media
-Splenomegaly
Name the skin change
Peau d'orange
Pedigree
What is the pattern of Mention 3 examples of
inheritance? conditions inherited by
this pattern?
Autosomal dominant Huntington's disease
Marfan’s syndrome
Achondroplasia
Describtion A peripheral blood smear showing
Ring-forms of Plasmodium falciparum
Complications •Respiratory distress
•Renal failure
•Cerebral malaria
Treatment Antimalarial agents e.g. Quinine
Describtion A peripheral blood smear Showing Hyper
segmented neutrophils
Diagnosis Megaloblastic anemia
Causes Vitamin B12 deficiency
Folate deficiency
Combined deficiency
Drugs : e.g. Methotrexate & Phenytoin
Diagnosis Fifth disease
(slapped cheek appearance)
Causative organism Parvo virus B19
Life threatening complications Bone marrow failure,
secondary infection and sepsis.
‫يم ﴾‬‫الرِح ِ‬‫الر ْح َم ِن َّ‬ ‫﴿ بِ ْس ِم اللّ ِه َّ‬
‫ات يَ ْه ِدي ِه ْم َربُّ ُه ْم بِِإميَاِنِِ ْم ََْت ِري ِمن ََْتتِ ِه ُم‬ ‫اِل ِ‬
‫َ‬
‫الص ِ‬
‫َّ‬ ‫ا‬
‫ْ‬‫و‬ ‫ل‬
‫ُ‬ ‫م‬‫ِ‬ ‫ع‬‫و‬ ‫ا‬
‫ْ‬‫و‬
‫َ َ ََ‬‫ن‬
‫ُ‬ ‫آم‬ ‫ين‬‫ذ‬‫ِ‬ ‫َّ‬
‫ل‬ ‫ا‬ ‫َّ‬
‫ن‬ ‫ِ‬
‫• إ‬
‫ك اللَّ ُه َّم َوََِتيَّتُ ُه ْم فِ َيها‬ ‫ن‬‫ا‬ ‫ح‬ ‫ب‬ ‫س‬ ‫ا‬ ‫يه‬
‫َ ْ َ ُ ْ َ ُْ َ َ َ‬
‫ِ‬
‫ف‬ ‫م‬ ‫اه‬ ‫و‬ ‫ع‬ ‫د‬ ‫﴾‬ ‫‪٩‬‬ ‫﴿‬ ‫ِ‬
‫م‬ ‫ي‬‫ِ‬‫َّع‬
‫ن‬ ‫ال‬ ‫ِ‬
‫َّات‬‫األَنْ َه ُار ِِف َجن‬
‫ني ﴿‪﴾١٠‬‬ ‫م‬‫ب الْعالَ ِ‬ ‫ِّ‬ ‫ر‬ ‫ِ‬
‫ه‬ ‫َّ‬
‫ل‬ ‫ِ‬‫ل‬ ‫د‬
‫ُ‬ ‫م‬‫اِل‬
‫ْ‬ ‫آخر د ْعواهم أ ِ‬
‫َن‬ ‫سالم و ِ‬
‫َ َ َ‬ ‫َْ‬ ‫َ ٌ َ ُ َ َُْ‬
‫• سورة يونس‬

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2014-2015

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Abdulla Ali Isa, MBBS

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Type of shock Most common cause

Diagnostic or radiological tool

Coronary Artery disease

Heart disease Hypertrophic obstructive Mitral valve prolapse Most murmurs

Angiotensin converting enzyme inhibitor

Classic clinical clues that suggest a diagnosis of renal-artery stenosis

How to differentiate between COPD and Asthma?

Light's criteria(suggests exudates) Causes of exudate Causes of transudate

First line therapy for TB Side effects

Causative organism Treatment

Mantoux tuberculin skin test

In Kaposi’s sarcoma occurring in AIDS patient

Antimicrobial treatment is advisable for Antimicrobial treatment is ineffective or

Hepatitis B markers Indications

HCV markers Indications

Laboratory markers and diagnostic methods

Disease EBV (Infectious mononucleosis)

Diagnostic and therapeutic tests

Primary biliary cirrhosis Primary sclerosing cholangitis

Disease Alpha-1 antitrypsin deficiency Wilson's disease

 Most useful prophylactic drug in Travelers’  Bismuth subsalicylate (Pepto-Bismol)

Bacterial food poisoning syndromes

Esophageal Variceal Bleeding

Plasma cell neoplasm

Classifications Oncologic Emergencies

Side effects of chemotherapy

G6PD enzyme deficiency

Megaloblastic Anemia (MCV>100)

Sickle cell disease

Disease Hodgkin's lymphoma Non-Hodgkin lymphoma

Type of lymphoma Renal complications

Types of cells in peripheral smears Possible cause

Types of anemia Microcytic anemia Normocytic anemia Macrocytic anemia

Indications for urgent dialysis

Diuretics used to treat Calcium disorders

Beta blocker K+ sparing diuretics ( Spironolactone)

Sodium imbalance correction complication

Disease Chronic renal failure DKA Acute pancreatitis

Diuretics Thiazide Loops diuretics Spironolactone

Nitrogen accumulation diseases

Compensation for Metabolic Acid/Base disorders

 Anion Gap = Na - (Cl + HCO3-)

Type of cast Association

CAUSES OF ACUTE RENAL FAILURE

Disease Cushing’s syndrome Acromegaly

Diabetic ketoacidosis (DKA) is  Serum PH<7.3

Multiple Endocrine Neoplasia syndromes

Common autoimmune thyroid diseases

Risk factors that increase diabetic

Pharmacologic Treatment  Metformin is well tolerated and there is

The following drugs have been associated  Bendrofluazide (Thiazide diuretics)

Laboratory findings in thyroid dysfunction

 Methimazole -Pregnancy Drug-induced

Osteoarthritis Rheumatoid Arthritis

Drug induced lupus

Diagnostic or radiological tool

Signs of Meningeal Irritation

Drug-induced -Reserpine Co-careldopaThe first medication used to

Wernicke’s encephalopathy Thiamine (vitamin b1) deficiency.